NPIMap

Organization Active NPI

Kootenai Health, Inc.

Doing business as Kootenai EKG group

  • Diagnostic Radiology Physician
  • Coeur d'Alene, ID
National Provider Identifier
1700918851
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
42 Issued in ID
Legal business name
KOOTENAI HEALTH, INC.
Doing business as
Kootenai EKG group
Practice address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone
(208) 625-4000
Fax
(208) 625-5731
NPI assigned
Mar 12, 2007
Last updated
Jan 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
KOOTENAI HEALTH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Authorized official

Name
Jon Ness
Title
Ceo
Phone
(208) 625-5081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 42 ID Primary

Addresses

Primary practice location

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4000

Other identifiers 3

IdentifierTypeStateIssuer
83758OtherIDBLUE CROSS
805712000MedicaidID
000010142664OtherIDREGENCE BLUE SHIELD

Other names 1

  • Kootenai EKG group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041214000230 ID Part B Supplier - Clinic/Group Practice 4789641598 Receives reassigned benefits from 359 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cottonwood, ID; Grangeville, ID; Kellogg, ID; Lewiston, ID; Moscow, ID; Orofino, ID; Post Falls, ID; Saint Maries, ID…
O20240111003252 ID Part B Supplier - Clinic/Group Practice 1355792276 Receives reassigned benefits from 526 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cottonwood, ID; Coeur D Alene, ID; Grangeville, ID; Kellogg, ID; Lewiston, ID; Moscow, ID; Orofino, ID; Post Falls, ID…

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Kootenai Health Inc9 organizations share this tax ID, including this one
Part of
Kootenai Health Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704412800000",
    "number": "1700918851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000",
            "fax_number": "208-625-5731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000",
            "fax_number": "208-625-5731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOTENAI HEALTH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KOOTENAI HEALTH, INC.",
        "enumeration_date": "2007-03-12",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A",
        "authorized_official_last_name": "NESS",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-625-5081"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "83758",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805712000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010142664",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kootenai EKG group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.