Individual provider Active NPI

Debora Caires Nelson, PT

  • Physical Therapist
  • Coeur d'Alene, ID
National Provider Identifier
1093742397
Registry record updated Oct 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-1343 Issued in ID
Practice address
2200 Ironwood PL
Coeur D Alene, ID 83814-2610
Phone
(208) 667-6486
Fax
(208) 676-8276
NPI assigned
Jun 26, 2006
Last updated
Oct 21, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-1343 ID Primary

Addresses

Primary practice location

2200 Ironwood PL
Coeur D Alene, ID 83814-2610

Mailing address

2200 Ironwood PL
Coeur D Alene, ID 83814-2610
Phone (208) 667-6486

Other identifiers 4

IdentifierTypeStateIssuer
000010138360OtherIDBLUE SHIELD
806161000MedicaidID
0161551OtherWALABOR AND INDUSTRY
T5410OtherIDBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101022000478 ID Practitioner - Physical Therapist in Private Practice 1658564646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shellman Inc PAGroup PAC ID 4981592938, 45 clinicians

Practice addresses (Care Compare)

1917 N Lakewood Dr
Coeur D Alene, ID 83814-2634
Phone (208) 664-8194

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT-1343IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Shellman Inc PA Physical Therapist CurrentSince Jan 27, 2024 Accepting new patients

Locations

1917 N Lakewood Dr
Coeur D Alene, ID 83814
Phone (208) 664-8194

1172 W Hayden Ave
Hayden, ID 83835
Phone (208) 762-3332

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1382313600000",
    "number": "1093742397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 IRONWOOD PL",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142610",
            "telephone_number": "208-667-6486",
            "fax_number": "208-676-8276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 IRONWOOD PL",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142610",
            "telephone_number": "208-667-6486",
            "fax_number": "208-676-8276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAIRES NELSON",
        "first_name": "DEBORA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2013-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-1343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010138360",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806161000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRY",
            "identifier": "0161551",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "T5410",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.