Individual provider Active NPI

Julie Kathleen McCardell, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Coeur d'Alene, ID
National Provider Identifier
1255312989
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
62943 Issued in ID
Practice address
1700 W Riverstone Dr
Coeur D Alene, ID 83814-5683
Phone
(208) 770-2822
Fax
(208) 770-2911
NPI assigned
Nov 9, 2005
Last updated
Mar 19, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP61232280 WA
Family Nurse Practitioner 363LF0000X 62943 ID Primary

Addresses

Primary practice location

1700 W Riverstone Dr
Coeur D Alene, ID 83814-5683

Mailing address

1807 N Hutchinson Rd
Spokane Valley, WA 99212-2444
Phone (509) 456-7414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211209000449 WA Practitioner - Nurse Practitioner 2365832185 Reassigns benefits to 2 organizations
I20231013001495 ID Practitioner - Nurse Practitioner 2365832185 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain West Derm - Blackhart PLLCGroup PAC ID 1153609813, shared by 7 NPIs, 103 clinicians

Practice addresses (Care Compare)

1700 W Riverstone Dr
Coeur D Alene, ID 83814-5683
Phone 51293039091255

1807 N Hutchinson Rd
Spokane Valley, WA 99212-2444
Phone 51293039091255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
62943IDMDFamily Nurse Practitioner
AP61232280WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain West Derm - Blackhart PLLC CurrentSince Dec 1, 2023 Accepting new patients
Mountain West Derm-Blackhart, PLLC CurrentSince Dec 1, 2023 Accepting new patients
Mountain West Derm-Blackhart, PLLC Current Accepting new patients
Spokane Dermatology Clinic PS CurrentSince Nov 12, 2021 Accepting new patients
Mountain West Derm - Blackhart PLLC Past Accepting new patients

Locations

7733 W Emerald St
Boise, ID 83704
Phone (208) 376-4777

1700 W Riverstone Dr
Coeur D Alene, ID 83814
Phone (208) 770-2822

324 S Sherman St
Ste A1
Spokane, WA 99202
Phone (509) 624-1184

5905 N Mayfair St
#200
Spokane, WA 99208
Phone 51293039091255

1807 N Hutchinson Rd
Spokane Valley, WA 99212
Phone (509) 456-3414

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1255312989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1807 N HUTCHINSON RD",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992122444",
            "telephone_number": "509-456-7414",
            "fax_number": "509-624-0763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W RIVERSTONE DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145683",
            "telephone_number": "208-770-2822",
            "fax_number": "208-770-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCARDELL",
        "first_name": "JULIE",
        "middle_name": "KATHLEEN",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61232280",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "62943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.