Heidi Rose Brackebusch, RDN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

7671544 Issued in ID

Practice address

1765 W Golf Course Rd
Coeur D Alene, ID 83815-9033

Phone

(208) 277-0795

NPI assigned

Dec 2, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Shellman Inc PA

  • Physical Therapist
  • Coeur D Alene, ID
  • NPI 1326050253
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1764633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778630400000",
    "number": "1477415982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1917 N LAKEWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 W GOLF COURSE RD",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838159033",
            "telephone_number": "208-277-0795"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1610 E Schneidmiller Ave",
            "address_purpose": "LOCATION",
            "city": "Post Falls",
            "state": "ID",
            "postal_code": "838547065",
            "country_code": "US",
            "telephone_number": "208-773-8111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2003 Kootenai Health Way",
            "address_purpose": "LOCATION",
            "city": "Coeur D Alene",
            "state": "ID",
            "postal_code": "838146051",
            "country_code": "US",
            "telephone_number": "208-625-6664",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRACKEBUSCH",
        "first_name": "HEIDI",
        "middle_name": "ROSE",
        "credential": "RDN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-12-02",
        "last_updated": "2026-05-13",
        "certification_date": "2026-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "ID",
            "license": "7671544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren A Boydston, MD
• Daniel Boylan
• Catherine A Boysen, DIETICIAN
• Chandler Bozarth, DDS
• Nina Sienna Bozinov, M.D.
• Rebecca R Bradley, LCPC, LMFT,LMHC, NCC
• Brittney C Brady, PA-C
• Rena L Bradymire, LPC
• Michael L Brandt, PHARMD
• Michah Brasseur, M.D.

• Registered Dietitian in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Registered Dietitian in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.