NPIMap

Individual provider Active NPI

Derek Kohlhase, MD

  • Family Medicine Physician
  • Star, ID
National Provider Identifier
1407410830
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-15600 Issued in ID
Practice address
10717 W State St
Star, ID 83669-6046
Phone
(208) 302-6300
Fax
(208) 302-6355
NPI assigned
May 1, 2019
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MRM-1814 ID
Family Medicine Physician 207Q00000X M-15600 ID Primary

Addresses

Primary practice location

10717 W State St
Star, ID 83669-6046

Mailing address

3340 E Goldstone Dr
Meridian, ID 83642-1026
Phone (208) 302-9342

Other practice location 1

215 E Hawaii Ave
Nampa, ID 83686-6011
Phone (208) 514-2529

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220803002492 ID Practitioner - Family Practice 5193052645 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota Medical School, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10717 W State St
Star, ID 83669-6046
Phone (208) 302-6300

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

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
Saint Alphonsus Regional Medical Center Inc Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Sep 1, 2022 Accepting new patients
Saint Alphonsus Regional Medical Center Inc Family Medicine CurrentSince Sep 1, 2022 Accepting new patients

Locations

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

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

3340 E Goldstone Dr
Meridian, ID 83642
Phone (208) 302-9342

215 E Hawaii Ave
Nampa, ID 83686
Phone (208) 463-3234

10717 W State St
Star, ID 83669
Phone (208) 302-6300

Interoperability endpoints

  • Direct secure messaging: dkohlhase2079846@direct.trinity-health.org

Organizations & group practices 3

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 12

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": "1556668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407410830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-9342",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10717 W STATE ST",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836696046",
            "telephone_number": "208-302-6300",
            "fax_number": "208-302-6355"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 E Hawaii Ave",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836866011",
            "country_code": "US",
            "telephone_number": "208-514-2529",
            "fax_number": "208-375-2217",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOHLHASE",
        "first_name": "DEREK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-01",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRM-1814",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-15600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Star, ID

Sources for this page

Verify at the official NPI Registry.