Individual provider Active NPI

Tanner Souza, DO

  • Family Medicine Physician
  • Coeur D Alene, ID
National Provider Identifier
1447837166
Registry record updated Sep 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0-1993 Issued in ID
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

Updated by the provider on Sep 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20231115001726 NV Practitioner - Family Practice 8729476676 Reassigns benefits to 1 organization
I20240919003808 ID Practitioner - Osteopathic Manipulative MedicinePractitioner - Family Practice 8729476676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
Touro Un Col of Osteopathic Medicine, Henderson, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Praxis Health PCGroup PAC ID 8325941446, 174 clinicians

Practice addresses (Care Compare)

1130 W Prairie Ave
Coeur D Alene, ID 83815-8780
Phone 87770811193

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0-1993IDMDFamily Medicine Physician
DO3477NVMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Praxis Health, PC CurrentSince Sep 30, 2024 Accepting new patients
Praxis Health, PC Family Medicine CurrentSince Sep 30, 2024 Accepting new patients
Signify Health Medical Associates, PLLC General Practice CurrentSince Jan 17, 2024 Accepting new patients
Own Family Medicine and Wellness LLC Dba Active Family Healthcare Family Medicine PastSince Jul 8, 2026 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.

Hospital & facility affiliations 5

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": "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

Verify at the official NPI Registry.