Robert John Haake, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

O-0520 Issued in ID

Practice address

500 E Shore Dr
Suite 100
Eagle, ID 83616-6908

Phone

(208) 995-2802

Fax

(208) 995-2804

NPI assigned

Aug 12, 2006

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 Oct 1, 2015 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

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.

• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1447299342
  NPD (past)
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)
• Ifath G. Bashiruddin M.D.S.C.

  • Specialist
  • Belleville, IL
  • NPI 1821287293
  NPD (past)

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373932800000",
    "number": "1295747046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 E SHORE DR",
            "address_2": "SUITE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166908",
            "telephone_number": "208-995-2802",
            "fax_number": "208-995-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 E SHORE DR",
            "address_2": "SUITE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166908",
            "telephone_number": "208-995-2802",
            "fax_number": "208-995-2804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAAKE",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2013-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "O-0520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00155781",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gabriel Guerrero, D.O.
• Tawnya Marie Hughes Guimond, LM, CPM
• Joshua Guinter, DPT
• Leslie Gwen Gunnerson, R.N., I.B.C.L.C.
• H&LL LLC
• Debbie Habig, PT
• Amber Ann Hackenberg, PA-C
• Christie Ann Hafer, D.C.
• Jeremai Joy Hafer, D.C.
• Tracy Lyn Hagadorn, CPM, LM

• Internal Medicine Physician in Eagle, ID
• Providers in Eagle, ID by specialty
• Internal Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.