Jonathan Craig Stevens, MD
Individual provider Active NPI Neuromusculoskeletal Medicine & OMM Physician · Ponderay, ID
NPI 1366495178 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1366495178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Neuromusculoskeletal Medicine & OMM Physician 204D00000X
- License
- M7507 (ID)
- Practice address
- 105 Vermeer Dr Unit 1
Ponderay, ID 83852-9802 - Phone
- (208) 266-1677
- Fax
- (208) 266-0440
- NPI assigned
- May 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shellman Inc PA | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | M7507 | ID | |
| Neuromusculoskeletal Medicine & OMM Physician | 204D00000X | M7507 | ID | Yes |
Addresses
Primary practice location
105 Vermeer Dr Unit 1
Ponderay, ID 83852-9802
Mailing address
PO Box 353
Clark Fork, ID 83811
Phone (208) 266-1677
Other practice location 1
750 N Syringa St Ste 203
Post Falls, ID 83854-5275
Phone (208) 266-1677
Other practice location 2
60319 Highway 200
Clark Fork, ID 83811
Phone (208) 266-1677
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 805192200 | Medicaid | ID |
Other names
- Dr. J Craig Stevens
Other providers in Ponderay, ID
- Nancy J Schmidt
- Traci D Schmidt
- Robert Seiberlich
- Bruce Spradlin
- Vern Stairs
- Stuart Gall Crna Inc
- Sunrise Speech and Language, LLC
- Travis Lee Taylor
- Kelcee Tomco
- Wal-Mart Stores, Inc
All providers in Ponderay, ID · Neuromusculoskeletal Medicine & OMM Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.