Active NPI
Tanner Souza, DO
- Family Medicine Physician
- Coeur D Alene, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0-1993
- Practice address
- 919 W Canfield Ave
Coeur D Alene, ID 83815-9764 - Phone
- (208) 758-0560
- NPI assigned
- Mar 27, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0-1993 | ID | Primary |
Addresses
Primary practice location
919 W Canfield Ave
Coeur D Alene, ID 83815-9764
Mailing address
919 W Canfield Ave
Coeur D Alene, ID 83815-9764
Phone (208) 758-0560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NV, ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Touro Un Col of Osteopathic Medicine, Henderson, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1130 W Prairie Ave
Coeur D Alene, ID 83815-8780
Phone 87770811193
Hospital & facility affiliations
- Centerwell Home Health
- Kootenai Health
- Northwest Specialty Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0-1993 | ID | MD | Family Medicine Physician |
| DO3477 | NV | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Praxis Health, PC | Current | Accepting new patients | |
| Praxis Health, PC | Family Medicine | Current | Accepting new patients |
| Signify Health Medical Associates, PLLC | General Practice | Current | Accepting new patients |
| Own Family Medicine and Wellness LLC Dba Active Family Healthcare | Family Medicine | Past | Accepting new patients |
Locations
701 S Carson St
Ste 200
Carson City, NV 89701
Phone (617) 586-0958
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Coeur D Alene, ID
- NPI 1942116884
-
- Rural Health Clinic/Center
- Dallas, OR
- NPI 1942925326
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Coeur D Alene, ID
- NPI 1639109762
-
- General Acute Care Hospital
- Coeur D Alene, ID
- NPI 1992798409
-
- General Acute Care Hospital
- Post Falls, ID
- NPI 1104824739
-
- Sleep Medicine (Psychiatry & Neurology) Physician
- Post Falls, ID
- NPI 1649123589
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616803200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788393600000",
"number": "1447837166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "919 W CANFIELD AVE",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838159764",
"telephone_number": "208-758-0560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "919 W CANFIELD AVE",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838159764",
"telephone_number": "208-758-0560"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUZA",
"first_name": "TANNER",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-27",
"last_updated": "2026-09-03",
"certification_date": "2026-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "0-1993",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.