Individual provider Active NPI

Jennifer Kloss Cook, MD

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1265680417
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-10406 Issued in ID
Practice address
325 W Idaho St
Boise, ID 83702-6040
Phone
(208) 514-2525
Fax
(208) 375-2217
NPI assigned
Aug 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-10406 ID Primary

Addresses

Primary practice location

325 W Idaho St
Boise, ID 83702-6040

Mailing address

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 367-6030

Other identifiers 1

IdentifierTypeStateIssuer
1265680417MedicaidID

Other names 1

  • Jennifer Louise Kloss Former name

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
I20090110000184 ID Practitioner - Family Practice 3072503770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wake Forest University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Full Circle Health IncGroup PAC ID 6709986797, 106 clinicians

Practice addresses (Care Compare)

2275 S Eagle Rd
Suite 120
Meridian, ID 83642-2620
Phone (208) 514-2520

325 W Idaho St
Boise, ID 83702-6040
Phone (208) 514-2525

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

Hospital & facility affiliations

  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Full Circle Health, Inc. CurrentSince Jan 2, 2009 Accepting new patients
St Lukes Regional Medical Center PastSince Jan 2, 2009 Accepting new patients

Locations

777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030

325 W Idaho St
Boise, ID 83702
Phone (208) 514-2525

6565 W Emerald St
Boise, ID 83704
Phone (208) 377-5055

215 W 35th St
Garden City, ID 83714
Phone (208) 384-5200

708 E Wythe Creek Ct
Ste 103
Kuna, ID 83634
Phone (208) 922-5130

2275 S Eagle Rd
Ste 120
Meridian, ID 83642
Phone (208) 514-2520

Interoperability endpoints

  • Direct secure messaging: jcook295100@direct.ochin.org

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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": "1219968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1265680417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-367-6030",
            "fax_number": "208-322-7018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "325 W IDAHO ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026040",
            "telephone_number": "208-514-2525",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "JENNIFER",
        "middle_name": "KLOSS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-29",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-10406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265680417",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "KLOSS",
            "middle_name": "LOUISE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.