NPIMap

Individual provider Active NPI

Joseph James Krakker III, D.O.

  • Family Medicine Physician
  • Salmon, ID
National Provider Identifier
1417397001
Registry record updated Feb 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-0946 Issued in ID
Practice address
203 S Daisy St
Salmon, ID 83467-4709
Phone
(208) 756-6212
Fax
(888) 789-1866
NPI assigned
Jun 27, 2013
Last updated
Feb 20, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2017

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 7858 AK
Family Medicine Physician 207Q00000X O-0946 ID Primary

Addresses

Primary practice location

203 S Daisy St
Salmon, ID 83467-4709

Mailing address

203 S Daisy St
Salmon, ID 83467-4709
Phone (208) 756-5600

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
I20160915002052 ID Practitioner - Family PracticePractitioner - Emergency Medicine 7911127188 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Emergency Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Steele Memorial Medical CenterGroup PAC ID 9436131265, 25 clinicians

Practice addresses (Care Compare)

203 S Daisy St
Salmon, ID 83467-4709
Phone (208) 756-5600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
7858AKMDFamily Medicine Physician
O-0946IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Steele Memorial Medical Center CurrentSince Jul 30, 2016 Accepting new patients
Steele Memorial Medical Center CurrentSince Jul 30, 2016 Accepting new patients
Steele Memorial Medical Center Past Accepting new patients

Locations

203 S Daisy St
Salmon, ID 83467
Phone (208) 756-4291

805 Main St
Salmon, ID 83467
Phone (208) 282-3495

Interoperability endpoints

  • Direct secure messaging: jkrakker298964@wm.providencedirect.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": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1417397001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 S DAISY ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834674709",
            "telephone_number": "208-756-5600",
            "fax_number": "888-789-1866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 S DAISY ST",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834674709",
            "telephone_number": "208-756-6212",
            "fax_number": "888-789-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAKKER",
        "first_name": "JOSEPH",
        "middle_name": "JAMES",
        "name_suffix": "III",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-27",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AK",
            "license": "7858",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salmon, ID

Sources for this page

Verify at the official NPI Registry.