Individual provider Active NPI

Jennifer A Watson, ARNP

  • Family Nurse Practitioner
  • Coeur d'Alene, ID
National Provider Identifier
1750344834
Registry record updated Nov 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP438A Issued in ID
Practice address
714 W Appleway Ave Ste 200
Coeur D Alene, ID 83814-9330
Phone
(208) 665-1552
Fax
(208) 665-1558
NPI assigned
Apr 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP438A ID Primary

Addresses

Primary practice location

714 W Appleway Ave Ste 200
Coeur D Alene, ID 83814-9330

Mailing address

714 W Appleway Ave Ste 200
Coeur D Alene, ID 83814-9330
Phone (208) 665-1552

Other identifiers 4

IdentifierTypeStateIssuer
805997200MedicaidID
805997201MedicaidID
805997202MedicaidID
805997203MedicaidID

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041005000550 ID Practitioner - Nurse Practitioner 2163481235 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Asthma and Allergy of Idaho PLLCGroup PAC ID 7416943782, 6 clinicians

Practice addresses (Care Compare)

714 W Appleway Ave
Suite 200
Coeur D Alene, ID 83814-9330
Phone (208) 665-1552

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.42 of 100Reported as group
Quality
100
Improvement activities
40
Cost
61.41

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP438AIDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Asthma & Allergy of Idaho PLLC CurrentSince Apr 1, 2009 Accepting new patients
Asthma & Allergy of Idaho PastSince Jan 17, 2021 Accepting new patients
Own Family Medicine and Wellness LLC Dba Active Family Healthcare PastSince Mar 14, 2022 Accepting new patients

Locations

1263 Bennett Ave
Ste 3
Burley, ID 83318
Phone (208) 678-1049

714 W Appleway Ave
Ste 200
Coeur D Alene, ID 83814
Phone (208) 655-1443

619 S Washington St
Ste 201
Moscow, ID 83843
Phone (208) 882-1777

30544 Highway 200
Ste 305
Ponderay, ID 83852
Phone (208) 665-1552

1502 Locust St N
Ste 600
Twin Falls, ID 83301
Phone (208) 734-6091

800 Falls Ave
Ste 2
Twin Falls, ID 83301
Phone (208) 734-6091

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605571200000",
    "number": "1750344834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 W APPLEWAY AVE STE 200",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838149330",
            "telephone_number": "208-665-1552",
            "fax_number": "208-665-1558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 W APPLEWAY AVE STE 200",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838149330",
            "telephone_number": "208-665-1552",
            "fax_number": "208-665-1558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "JENNIFER",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2020-11-17",
        "certification_date": "2020-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP438A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805997200",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805997201",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805997202",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805997203",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.