Fredrick Mark Owsley, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

M6701 Issued in ID

Practice address

980 W Ironwood Dr
Ste 206
Coeur D Alene, ID 83814-2668

Phone

(208) 664-0165

Fax

(208) 664-5695

NPI assigned

Nov 9, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 1, 2019 through Jan 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1265413017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 W IRONWOOD DR",
            "address_2": "STE 206",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142668",
            "telephone_number": "208-664-0165",
            "fax_number": "208-664-5695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 W IRONWOOD DR",
            "address_2": "STE 206",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142668",
            "telephone_number": "208-664-0165",
            "fax_number": "208-664-5695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OWSLEY",
        "first_name": "FREDRICK",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "M6701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002781300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Rose Owens, PTA
• Melissa Mary Owens, LMSW
• Mikyah Hope Owens, RDN, LD
• Philip L Owens, LCSW
• Own Family Medicine and Wellness LLC Dba Active Family Healthcare
• Pacific Capital and Consulting, LLC
• Pacifica L 44 LLC
• Pacifica Sherman LLC
• Jeanna Padilla, CPNP-PC
• Tye Padilla, DMD

• Specialist in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.