NPIMap

Organization Active NPI

Kootenai Health, Inc.

Doing business as Kootenai Medical Center Group

  • Emergency Medicine Physician
  • Coeur d'Alene, ID
National Provider Identifier
1235288655
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
42 Issued in ID
Legal business name
KOOTENAI HEALTH, INC.
Doing business as
Kootenai Medical Center Group
Practice address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone
(208) 625-4000
NPI assigned
Jan 9, 2007
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Jon Ness
Title
Ceo
Phone
(208) 625-5081

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 42 ID
Nurse Practitioner 363L00000X 42 ID
Emergency Medicine Physician 207P00000X 42 ID Primary
Neurological Surgery Physician 207T00000X
Orthopaedic Surgery Physician 207X00000X
Otolaryngology Physician 207Y00000X 42 ID
Pediatrics Physician 208000000X
Surgery Physician 208600000X 42 ID
Urology Physician 208800000X 42 ID
Podiatrist 213E00000X 42 ID

Addresses

Primary practice location

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4000

Other identifiers 4

IdentifierTypeStateIssuer
CG7380OtherIDRR MEDICARE
83758OtherIDBLUE CROSS
805712000MedicaidID
000010004926OtherIDREGENCE BLUE SHIELD

Other names 1

  • Kootenai Medical Center Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041214000230 ID Part B Supplier - Clinic/Group Practice 4789641598 Receives reassigned benefits from 359 practitioners
8 other NPIs on this enrollment
Practice locations: Cottonwood, ID; Grangeville, ID; Kellogg, ID; Lewiston, ID; Moscow, ID; Orofino, ID; Post Falls, ID; Saint Maries, ID…
O20240111003252 ID Part B Supplier - Clinic/Group Practice 1355792276 Receives reassigned benefits from 526 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cottonwood, ID; Coeur D Alene, ID; Grangeville, ID; Kellogg, ID; Lewiston, ID; Moscow, ID; Orofino, ID; Post Falls, ID…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Kootenai Health Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations (25 of 41)

1420 Lincoln Way
Ste 500
Coeur D Alene, ID 83814
Phone (208) 667-8474

1919 Lincoln Way
Coeur D Alene, ID 83814
Phone (208) 625-4255

1919 Lincoln Way
Ste 211
Coeur D Alene, ID 83814
Phone (208) 625-4700

2003 Kootenai Health Way
#310
Coeur D Alene, ID 83814

2003 Kootenai Health Way
Ste 300
Coeur D Alene, ID 83814
Phone (208) 625-4120

2003 Kootenai Health Way
Ste 301
Coeur D Alene, ID 83814

2177 W Ironwood Center Dr
Coeur D Alene, ID 83814
Phone (208) 625-6111

2199 W Ironwood Center Dr
Coeur D Alene, ID 83814
Phone (208) 625-4888

2288 N Merritt Creek Loop
Ste 200
Coeur D Alene, ID 83814
Phone (208) 625-3800

2301 N Ironwood Pl
Coeur D Alene, ID 83814
Phone (208) 625-4803

2366 N Merritt CRK Loop a
Coeur D Alene, ID 83814

423 N 3Rd St Ste 355
Coeur D Alene, ID 83814

700 W Ironwood Dr
Ste 120
Coeur D Alene, ID 83814
Phone (208) 625-3640

700 W Ironwood Dr
Ste 246
Coeur D Alene, ID 83814
Phone (208) 625-5688

700 W Ironwood Dr
Ste 258
Coeur D Alene, ID 83814
Phone (208) 625-6799

700 W Ironwood Dr
Ste 275W
Coeur D Alene, ID 83814
Phone (208) 625-4780

700 W Ironwood Dr
Ste 278
Coeur D Alene, ID 83814
Phone (208) 625-5160

700 W Ironwood Dr
Ste 341
Coeur D Alene, ID 83814
Phone (208) 625-5200

700 W Ironwood Dr
Ste 35
Coeur D Alene, ID 83814

700 W Ironwood Dr
Ste 378
Coeur D Alene, ID 83814
Phone (208) 625-3555

900 W Ironwood Dr Ste 236
Coeur D Alene, ID 83814

920 W Ironwood Dr
Coeur D Alene, ID 83814
Phone (208) 625-4965

920 W Ironwood Dr
Ste 201
Coeur D Alene, ID 83814
Phone (208) 625-4965

8556 N Wayne Dr
Hayden, ID 83835
Phone (208) 618-5164

1055 Riverside Ave
Moscow, ID 83844

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Clearwater Valley Hospital & ClinicsOrofino, ID, CCN 131320 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2020
St. Mary's HealthCottonwood, ID, CCN 131321 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2020
Northern Idaho Advanced Care HospitalPost Falls, ID, CCN 132001 Hospital 5% Or Greater Direct Ownership Interest (25%) Sep 1, 2025
St Marys Hospital IncCottonwood, ID, CCN 13Z321 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2020
Clearwater Valley Hospital & ClinicsOrofino, ID, CCN 13Z320 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2020
Rehabilitation Hospital of the NorthwestPost Falls, ID, CCN 133027 Hospital 5% Or Greater Direct Ownership Interest (25%) Oct 31, 2012
Northern Idaho Advanced Care HospitalPost Falls, ID, CCN 13TA01 Hospital 5% Or Greater Direct Ownership Interest (25%) Sep 1, 2025
Clearwater Valley Hospital & Clinics IncPierce, ID, CCN 133989 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2020

Owned or controlled facilities with NPI records 16

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 16

Practitioners & affiliated clinicians

Practitioners 547

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 547

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1235288655",
    "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": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOTENAI HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "NESS",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-625-5081"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "42",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "42",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "42",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "ID",
            "license": "42",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "42",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "42",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "ID",
            "license": "42",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CG7380",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "83758",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805712000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010004926",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kootenai Medical Center Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kootenai Medical Center Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.