Fred Michael Itveldt, MSN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

AP 60451837 Issued in WA

Practice address

12615 E Mission Ave Ste 310
Spokane Valley, WA 99216-1047

Phone

(509) 707-8581

Fax

(509) 443-5269

NPI assigned

Mar 6, 2014

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA, ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mental Wellness Clinic of Coeur D Alene IncGroup PAC ID 9537434014, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mental Wellness Clinic of Coeur D Alene Inc

  • Community/Behavioral Health Agency
  • Coeur d'Alene, ID
  • NPI 1871713925
  Medicare reassignment Care Compare group NPD
• Psychiatric Services and Medication Management Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Spokane Valley, WA
  • NPI 1710477807
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1394064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1619393204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12615 E MISSION AVE STE 310",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161047",
            "telephone_number": "509-707-8581",
            "fax_number": "509-443-5269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12615 E MISSION AVE STE 310",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161047",
            "telephone_number": "509-707-8581",
            "fax_number": "509-443-5269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITVELDT",
        "first_name": "FRED",
        "middle_name": "MICHAEL",
        "credential": "MSN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-06",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WA",
            "license": "AP60451837",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP 60451837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Molly Alexandrea Ironmonger, SUDP
• Rachel Kay Irwin
• Isaac Caring Home LLC
• Isd Renal Inc (Spokane Valley Renal Center)
• Kristopher Alan Isherwood
• Blessing Iwuozo
• J Blake, DMD, PS (KidSmile Dental)
• Taylor Jacklin, LMP
• Holly Jackson, PHARMD
• Judith Lynn Jackson

• Psychiatric/Mental Health Nurse Practitioner in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; 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.

Verify at the official NPI Registry.