Hailey J Rose, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

LL1272 Issued in SC

Practice address

6615 Comanche St
Kaniksu Health Services
Bonners Ferry, ID 83805

Phone

(208) 267-1718

Fax

(208) 267-9197

NPI assigned

Jul 7, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Hailey J Larson Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hailey.rose.p1@direct.kch.nextgenshare.com
• Direct secure messaging: hailey.rosedo.p90@direct.kootenai.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Boundary Community Hospital

  • Critical Access Hospital
  • Bonners Ferry, ID
  • NPI 1801896683
  Medicare reassignment NPD
• Boundary Community Hospital

  dba Boundary Community Clinics

  • Rural Health Clinic/Center
  • Bonners Ferry, ID
  • NPI 1801273552
  NPD
• Boundary Regional Community Health Center, Inc.

  dba Kaniksu Community Health

  • Federally Qualified Health Center (FQHC)
  • Priest River, ID
  • NPI 1538447727
  NPD
• Boundary Regional Community Health Center Inc

  dba Kaniksu Community Health

  • Federally Qualified Health Center (FQHC)
  • Bonners Ferry, ID
  • NPI 1306883244
  NPD (past)

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

{
    "created_epoch": "1246924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347580800000",
    "number": "1679702088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX Q",
            "address_2": "KANIKSU HEALTH SERVICES",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838051200",
            "telephone_number": "208-267-1718",
            "fax_number": "208-267-9197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 COMANCHE ST",
            "address_2": "KANIKSU HEALTH SERVICES",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "83805",
            "telephone_number": "208-267-1718",
            "fax_number": "208-267-9197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "HAILEY",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-07",
        "last_updated": "2012-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL1272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HAILEY",
            "last_name": "LARSON",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Riverstone Billing Services Inc (Cascara Counseling)
• Rocky Mountain Transportation
• Pamela S Roper, LM
• Robert Rossi, LCSW
• Janice Decordova Rudeen
• Lori Anne Sabin, LM, CPM
• Safeway Inc (Safeway Pharmacy #2954)
• Sandpoint Pediatrics LLP

• Pediatrics Physician in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.