NPIMap

Organization Active NPI

Coeur Obstetrics and Gynecology, PLLC

  • Specialist
  • Coeur d'Alene, ID
National Provider Identifier
1730280744
Registry record updated May 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
M-9485 Issued in ID
Legal business name
COEUR OBSTETRICS AND GYNECOLOGY, PLLC
Practice address
980 W Ironwood Dr Ste 201
Coeur D Alene, ID 83814-2668
Phone
(208) 765-4888
NPI assigned
Sep 25, 2006
Last updated
May 14, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2020

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

Authorized official

Name
Dr. Andrew Anthony Henneberg, MDNPI 1689603847
Title
Owner/MD
Phone
(208) 765-4888

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X M-9485 ID Primary

Addresses

Primary practice location

980 W Ironwood Dr Ste 201
Coeur D Alene, ID 83814-2668

Mailing address

980 W Ironwood Dr.
Suite 201
Coeur D' Alene, ID 83814
Phone (208) 765-4888

Other practice location 1

980 W Ironwood Dr.
Suite 304
Coeur D' Alene, ID 83814
Phone (208) 765-4888

Other names 1

  • D. Anthony & R. Randel Henneberg, PTR's Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060927000560 ID Part B Supplier - Clinic/Group Practice 1951306844 Receives reassigned benefits from 7 practitioners
Practice locations: Coeur D Alene, ID

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0699570Coeur Obstetrics and Gynecology PLLC980 W Ironwood Dr #201, Coeur D'Alene, ID 83814Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Locations

914 W Ironwood Dr
Ste 201
Coeur D Alene, ID 83814
Phone (208) 765-4888

980 W Ironwood Dr
Ste 201
Coeur D Alene, ID 83814
Phone (208) 292-1315

980 W Ironwood Dr
Ste 304
Coeur D Alene, ID 83814
Phone (208) 765-4888

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72467

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589414400000",
    "number": "1730280744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 W IRONWOOD DR.",
            "address_2": "SUITE 201",
            "city": "COEUR D' ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-765-4888",
            "fax_number": "208-667-8618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 W IRONWOOD DR STE 201",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142668",
            "telephone_number": "208-765-4888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "980 W IRONWOOD DR.",
            "address_2": "SUITE 304",
            "address_purpose": "LOCATION",
            "city": "COEUR D' ALENE",
            "state": "ID",
            "postal_code": "83814",
            "country_code": "US",
            "telephone_number": "208-765-4888",
            "fax_number": "208-667-8618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COEUR OBSTETRICS AND GYNECOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A",
        "authorized_official_last_name": "HENNEBERG",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "208-765-4888",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "M-9485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "D. Anthony & R. Randel Henneberg, PTR's",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "D. Anthony & R. Randel Henneberg, PTR's",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 May 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.