NPIMap

Organization Active NPI

Kootenai Tribe of Idaho

  • Clinic/Center
  • Bonners Ferry, ID
National Provider Identifier
1669594057
Registry record updated Oct 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
KOOTENAI TRIBE OF IDAHO
Practice address
100 Circle Drive
Bonners Ferry, ID 83805-1279
Phone
(208) 267-5223
Fax
(208) 267-8419
NPI assigned
Apr 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2010

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

Authorized official

Name
Karen K Hanson
Title
Health Clinic Director
Phone
(208) 267-5223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

100 Circle Drive
Bonners Ferry, ID 83805-1279

Mailing address

PO Box T
Bonners Ferry, ID 83805-1279
Phone (208) 267-5223

Other identifiers 3

IdentifierTypeStateIssuer
G007100MedicaidID
DC786OtherIDBLUE CROSS
DC786OtherIDHMO

Other names 1

  • Kootenai Tribal Health Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130517000477 ID Part B Supplier - Clinic/Group Practice 7315184926 Receives reassigned benefits from 6 practitioners
Practice locations: Bonners Ferry, ID
O20130520000003 TX Part B Supplier - Clinic/Group Practice 7315184926 Receives reassigned benefits from 1 practitioner
Practice locations: Bonners Ferry, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1669594057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX T",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838051279",
            "telephone_number": "208-267-5223",
            "fax_number": "208-267-8419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CIRCLE DRIVE",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838051279",
            "telephone_number": "208-267-5223",
            "fax_number": "208-267-8419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOTENAI TRIBE OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "HEALTH CLINIC DIRECTOR",
        "authorized_official_telephone_number": "208-267-5223"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G007100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "DC786",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HMO",
            "identifier": "DC786",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kootenai Tribal Health Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bonners Ferry, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.