Active NPI
Terry Evert Davenport, DO
- Family Medicine Physician
- St Maries, ID
National Provider Identifier
1710974191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- O-130
- Practice address
- 229 S 8TH St
St Maries, ID 83861-1813 - Phone
- (208) 245-2591
- Fax
- (208) 245-5246
- NPI assigned
- Sep 30, 2005
- Last updated
- Nov 15, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician | 208M00000X | O-130 | ID | |
| Family Medicine Physician | 207Q00000X | O-130 | ID | Primary |
Addresses
Primary practice location
229 S 8TH St
St Maries, ID 83861-1813
Mailing address
229 S 8TH St
St Maries, ID 83861-1813
Phone (208) 245-2591
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 601415700 | Other | DEEIOC | |
| S1303 | Other | ID | BLUE CROSS OF ID |
| 123363 | Other | WA | DEPT OF LABOR&INDUSTRIES |
| 8434839 | Medicaid | WA | |
| 805169900 | Medicaid | ID | |
| 000010004699 | Other | ID | REGENCE BS OF ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O-130 | ID | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1700006400000",
"number": "1710974191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "229 S 8TH ST",
"city": "ST MARIES",
"state": "ID",
"postal_code": "838611813",
"telephone_number": "208-245-2591",
"fax_number": "208-245-5246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 S 8TH ST",
"city": "ST MARIES",
"state": "ID",
"postal_code": "838611813",
"telephone_number": "208-245-2591",
"fax_number": "208-245-5246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVENPORT",
"first_name": "TERRY",
"middle_name": "EVERT",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-30",
"last_updated": "2023-11-15",
"certification_date": "2023-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "ID",
"license": "O-130",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "O-130",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEEIOC",
"identifier": "601415700",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF ID",
"identifier": "S1303",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR&INDUSTRIES",
"identifier": "123363",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8434839",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805169900",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BS OF ID",
"identifier": "000010004699",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Maries, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.