Individual provider Active NPI

Kenneth Jenson Bramwell, MD

  • Emergency Medicine Physician
  • Boise, ID
National Provider Identifier
1124065214
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
M8736 Issued in ID
Practice address
190 E Bannock St
Boise, ID 83712-6241
Phone
(208) 381-2222
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X M8736 ID
Emergency Medicine Physician 207P00000X M8736 ID Primary

Addresses

Primary practice location

190 E Bannock St
Boise, ID 83712-6241

Mailing address

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041022000283 ID Practitioner - Emergency Medicine 7911968052 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M8736IDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Oct 1, 2020 Accepting new patients
Department of Pediatrics University of Utah Past Accepting new patients
Pediatric Emergency Medicine Department of University of Utah PastSince Apr 1, 2006 Accepting new patients
Utah Emergency Physicians Emergency Medicine Past Accepting new patients
University of Utah Emergency Physicians Past Accepting new patients
University of Utah Emergency Physicians Emergency Medicine Past Accepting new patients

Locations

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

520 S Eagle Rd
Meridian, ID 83642
Phone (208) 706-5000

Organizations & group practices 7

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

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1124065214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-2222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAMWELL",
        "first_name": "KENNETH",
        "middle_name": "JENSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "ID",
            "license": "M8736",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M8736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.