Active NPI
Jeanna Rae Rendo, NP-C
- Nurse Practitioner
- Fruitland, ID
National Provider Identifier
1205466281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 60528
- Practice address
- 811 NW 12TH St
Fruitland, ID 83619-2268 - Phone
- (208) 452-7450
- NPI assigned
- Jan 18, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 60528 | ID | |
| Nurse Practitioner | 363L00000X | 60528 | ID | Primary |
Addresses
Primary practice location
811 NW 12TH St
Fruitland, ID 83619-2268
Mailing address
233 E North St
Grangeville, ID 83530-1838
Phone (208) 695-6668
Other practice location 1
113 S A St
Grangeville, ID 83530-1428
Phone (208) 717-4940
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
113 S a St
Grangeville, ID 83530-1428
Phone (208) 717-4940
811 NW 12TH St
Fruitland, ID 83619-2268
Phone (208) 452-7450
Hospital & facility affiliations
- Syringa General Hospital
- St Mary'S Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.2 of 100
- Quality
- 74.91
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60528 | ID | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Haug Chiropractic Clinic, P.a. | Current | Accepting new patients | |
| Idaho County Dermatology, PLLC | Nurse Practitioner | Current | Accepting new patients |
| Issc Fruitland | Current | Accepting new patients |
Locations
811 NW 12th St
Fruitland, ID 83619
Phone (208) 452-7450
113 S A St
Grangeville, ID 83530
Phone (208) 695-6668
Interoperability endpoints
- jeanna.rendo.p1@direct.ctdermpc.nextgenshare.com
Organizations & group practices 3
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.
-
- Nurse Practitioner
- Grangeville, ID
- NPI 1922835859
-
- Dermatology Physician
- Fruitland, ID
- NPI 1568112688
-
- Clinic/Center
- Grangeville, ID
- NPI 1881830297
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Durable Medical Equipment & Medical Supplies
- Cottonwood, ID
- NPI 1174673552
Hospital
-
- Critical Access Hospital
- Cottonwood, ID
- NPI 1841292307
-
- Critical Access Hospital
- Grangeville, ID
- NPI 1750336608
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1738886400000",
"number": "1205466281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "233 E NORTH ST",
"city": "GRANGEVILLE",
"state": "ID",
"postal_code": "835301838",
"telephone_number": "208-695-6668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 NW 12TH ST",
"city": "FRUITLAND",
"state": "ID",
"postal_code": "836192268",
"telephone_number": "208-452-7450"
}
],
"practiceLocations": [
{
"address_1": "113 S A St",
"address_purpose": "LOCATION",
"city": "Grangeville",
"state": "ID",
"postal_code": "835301428",
"country_code": "US",
"telephone_number": "208-717-4940",
"fax_number": "208-717-4990",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RENDO",
"first_name": "JEANNA",
"middle_name": "RAE",
"name_prefix": "Mrs.",
"credential": "NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-18",
"last_updated": "2025-02-07",
"certification_date": "2025-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "ID",
"license": "60528",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "ID",
"license": "60528",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fruitland, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.