Jeffrey C Anderson, NP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Rexburg, ID
NPI 1497197891 · NPPES record last updated Mar 19, 2025
Key facts
- NPI
- 1497197891
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- NP-1314A (ID)
- Practice address
- 1069 Summers Dr Ste B
Rexburg, ID 83440-5335 - Phone
- (208) 607-9816
- Fax
- (208) 549-7883
- NPI assigned
- Jul 25, 2013
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jamestown S'Klallam Tribe
Practice addresses (Care Compare)
808 N 5TH Ave
Sequim, WA 98382-3045
Phone (360) 683-5900
Hospital & facility affiliations
- Olympic Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240927000761 | WA | Practitioner - Nurse Practitioner | 4385878149 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP-1314A | ID | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jamestown S'Klallam Tribe | Current | Accepting new patients | |
| Jamestown S'Klallam Tribe | Current |
Accepting new patients | |
| Jamestown S'Klallam Tribe | Current |
Accepting new patients |
Locations
526 S 9th Ave
Sequim, WA 98382
Phone (360) 681-7755
808 N 5th Ave
Sequim, WA 98382
Phone (360) 582-4840
Interoperability endpoints
- janderson3271104@wm.providencedirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | NP-1314A | ID | Yes |
Addresses
Primary practice location
1069 Summers Dr Ste B
Rexburg, ID 83440-5335
Mailing address
1069 Summers Dr Ste B
Rexburg, ID 83440-5335
Phone (208) 607-9816
Other practice location 1
808 N 5th Ave
Sequim, WA 98382-3045
Phone (360) 683-5900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2283927 | Medicaid | WA |
Other providers in Rexburg, ID
- Matthew Hardy Allred
- Alpine Dermatology Clinic P.C.
- Scott Kay Andersen
- David Howard Anderson
- Emma Anderson
- Jeffrey D. Anderson
- Julie Marie Anderson
- Michael Anderson
- Rebecca Jo Anderson
- Rylie Anderson
All providers in Rexburg, ID · Psychiatric/Mental Health Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.