Active NPI
Tracey Koch, FNP
- Family Medicine Physician
- Sandpoint, ID
National Provider Identifier
1295741239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- NP461A
- Practice address
- 420 N Second Ave
Suite 100
Sandpoint, ID 83864-1565 - Phone
- (208) 265-2242
- Fax
- (208) 265-8214
- NPI assigned
- Jul 31, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NP461A | ID | Primary |
Addresses
Primary practice location
420 N Second Ave
Suite 100
Sandpoint, ID 83864-1565
Mailing address
420 N Second Ave
Suite 100
Sandpoint, ID 83864-1565
Phone (208) 265-2242
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806191100 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP461A | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338508800000",
"number": "1295741239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 N SECOND AVE",
"address_2": "SUITE 100",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641565",
"telephone_number": "208-265-2242",
"fax_number": "208-265-8214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 N SECOND AVE",
"address_2": "SUITE 100",
"city": "SANDPOINT",
"state": "ID",
"postal_code": "838641565",
"telephone_number": "208-265-2242",
"fax_number": "208-265-8214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOCH",
"first_name": "TRACEY",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2012-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "NP461A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806191100",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sandpoint, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.