Individual provider Active NPI

Jennifer Kaye Cook, APRN

  • Family Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1073858049
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-1525A Issued in ID
Practice address
1618 S Millenium Way
Meridian, ID 83642-6439
Phone
(208) 884-3376
Fax
(208) 884-0858
NPI assigned
Dec 3, 2012
Last updated
Aug 10, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-1525A ID Primary

Addresses

Primary practice location

1618 S Millenium Way
Meridian, ID 83642-6439

Mailing address

1618 S Millenium Way
Meridian, ID 83642-6439
Phone (208) 884-3376

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jennifer1@adawest.emadirect.md Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150323002003 ID Practitioner - Nurse Practitioner 3870726151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ada West Dermatology, P.C.Group PAC ID 1153341532, 26 clinicians

Practice addresses (Care Compare)

1618 S Millenium Way
Suite 100
Meridian, ID 83642-6457
Phone (208) 884-3376

Merit-based Incentive Payment System (MIPS)

Final score
77.64 of 100Reported as group
Quality
70.07
Promoting interoperability
100
Improvement activities
40
Cost
55.38

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-1525AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ada West Dermatology, PC CurrentSince Jan 1, 2015 Accepting new patients

Locations

1618 S Millenium Way
Meridian, ID 83642
Phone (208) 884-3376

1618 S Millenium Way
Ste 100
Meridian, ID 83642
Phone (208) 884-3376

Interoperability endpoints

  • Direct secure messaging: jennifer1@adawest.emadirect.md

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660089600000",
    "number": "1073858049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1618 S MILLENIUM WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426439",
            "telephone_number": "208-884-3376",
            "fax_number": "208-884-0858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1618 S MILLENIUM WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426439",
            "telephone_number": "208-884-3376",
            "fax_number": "208-884-0858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "JENNIFER",
        "middle_name": "KAYE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-03",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-1525A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jennifer1@adawest.emadirect.md",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1618 S Millenium Way",
            "city": "Meridian",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836426439",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.