Travis Charles Headley, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA406 Issued in ID

Practice address

850 W Ironwood Dr Ste 202
Coeur D Alene, ID 83814-4903

Phone

(208) 664-2175

Fax

(208) 664-1226

NPI assigned

Aug 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

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 1

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic Surgery and SportsGroup PAC ID 3375519168, 28 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwest Specialty Hospital Hospital, Post Falls, ID, CCN 130066
• Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049
• Bonner General Hospital Hospital, Sandpoint, ID, CCN 131328
• Boundary Community Hospital Hospital, Bonners Ferry, ID, CCN 131301
• Shoshone Medical Center Hospital, Kellogg, ID, CCN 131314

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theadley@ossmidaho.emadirect.md

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.

• Orthopedic Surgery and Sports

  • Orthopaedic Surgery Physician
  • Coeur D Alene, ID
  • NPI 1083729438

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Kootenai Health, Inc.

  • Psychiatry Physician
  • Coeur D Alene, ID
  • NPI 1174661151
  Medicare reassignment NPD
• Kootenai Health, Inc.

  • Emergency Medicine Physician
  • Coeur D Alene, ID
  • NPI 1235288655
  Medicare reassignment
• Kootenai Health, Inc.

  • Community/Retail Pharmacy
  • Hayden, ID
  • NPI 1235986290
  NPD
• Kootenai Health, Inc.

  • Hematology & Oncology Physician
  • Coeur D Alene, ID
  • NPI 1699807743
  NPD
• Incyte Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Spokane Valley, WA
  • NPI 1326086745
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bonner General Hospital Inc.

  • Critical Access Hospital
  • Sandpoint, ID
  • NPI 1154563963
  Care Compare affiliation
• Boundary Community Hospital

  • Critical Access Hospital
  • Bonners Ferry, ID
  • NPI 1801896683
  Care Compare affiliation
• Kootenai Health, Inc.

  • General Acute Care Hospital
  • Coeur D Alene, ID
  • NPI 1992798409
  Care Compare affiliation
• North Idaho Day Surgery LLC

  • Multi-Specialty Clinic/Center
  • St Maries, ID
  • NPI 1093674301

  Hospital

  Care Compare affiliation
• North Idaho Day Surgery LLC

  • General Acute Care Hospital
  • Post Falls, ID
  • NPI 1104824739
  Care Compare affiliation
• North Idaho Day Surgery LLC

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Post Falls, ID
  • NPI 1649123589

  Hospital

  Care Compare affiliation
• Shoshone Medical Center

  • Critical Access Hospital
  • Kellogg, ID
  • NPI 1043215437
  Care Compare affiliation

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1659484483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 W IRONWOOD DR",
            "address_2": "SUITE 202",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144903",
            "telephone_number": "208-664-2175",
            "fax_number": "208-664-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 W IRONWOOD DR STE 202",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144903",
            "telephone_number": "208-664-2175",
            "fax_number": "208-664-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEADLEY",
        "first_name": "TRAVIS",
        "middle_name": "CHARLES",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA406",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "theadley@ossmidaho.emadirect.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "850 W Ironwood Dr",
            "address_2": "SUITE 202",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838144903",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• McKenna Hays
• Melodie R Hays, PA-C
• Margaret S. Haywood, LPC
• Tiffany Hazen
• Head Sport Em LLC
• Healing Hearts Mental Health Therapy
• Healing Restorations PLLC
• Healing Through Connections LLC
• Health Sport LLC
• Hearts at Home LLC

• Physician Assistant in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; 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.