Individual provider Active NPI

Titus Kener

  • Family Nurse Practitioner
  • Pocatello, ID
National Provider Identifier
1356876551
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
55627 Issued in ID
Practice address
1200 Hospital Way
Pocatello, ID 83201-2708
Phone
(208) 232-2570
NPI assigned
Apr 25, 2017
Last updated
Apr 25, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 55627 ID Primary

Addresses

Primary practice location

1200 Hospital Way
Pocatello, ID 83201-2708

Mailing address

5970 Ruth St
Chubbuck, ID 83202-2079
Phone (208) 241-7517

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170720000546 ID Practitioner - Nurse Practitioner 4183994346 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MVH Pic LLCGroup PAC ID 6709156904, 16 clinicians

Practice addresses (Care Compare)

134 W Chubbuck Rd
Suite B
Chubbuck, ID 83202-2383
Phone (208) 237-7911

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
55627IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Mental Health Services PastSince May 1, 2018 Accepting new patients
Mountain View Hospital LLC PastSince May 1, 2018 Accepting new patients
New Horizons Mental Wellness Clinics Past Accepting new patients

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 4

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": "1493078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493078400000",
    "number": "1356876551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5970 RUTH ST",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022079",
            "telephone_number": "208-241-7517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012708",
            "telephone_number": "208-232-2570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENER",
        "first_name": "TITUS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-25",
        "last_updated": "2017-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "55627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.