Active NPI
James W Dutkiewicz, PA
- Physician Assistant
- Coeur d'Alene, ID
National Provider Identifier
1114992179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA129
- Practice address
- 2121 W Ironwood Center Dr
Coeur D Alene, ID 83814-2639 - Phone
- (208) 625-4680
- Fax
- (208) 625-4681
- NPI assigned
- Feb 22, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA129 | ID | Primary |
Addresses
Primary practice location
2121 W Ironwood Center Dr
Coeur D Alene, ID 83814-2639
Mailing address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA129 | ID | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140566400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475712000000",
"number": "1114992179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2003 KOOTENAI HEALTH WAY",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838146051",
"telephone_number": "208-625-4000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2121 W IRONWOOD CENTER DR",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142639",
"telephone_number": "208-625-4680",
"fax_number": "208-625-4681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUTKIEWICZ",
"first_name": "JAMES",
"middle_name": "W",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-22",
"last_updated": "2016-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA129",
"primary": true
}
],
"identifiers": [],
"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 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.