Individual provider Active NPI

Jessica Lujan, APRN-CNP

  • Family Nurse Practitioner
  • Coeur d'Alene, ID
National Provider Identifier
1750936522
Registry record updated Mar 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71672 Issued in ID
Practice address
1130 W Prairie Ave
Coeur D Alene, ID 83815-8780
Phone
(208) 209-0288
Fax
(208) 209-0289
NPI assigned
Aug 7, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 57250 NM
Family Nurse Practitioner 363LF0000X 71672 ID Primary

Addresses

Primary practice location

1130 W Prairie Ave
Coeur D Alene, ID 83815-8780

Mailing address

303 Paseo de Peralta
Santa Fe, NM 87501-1860
Phone (505) 988-2449

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
I20220421001862 ID Practitioner - Nurse Practitioner 5698162618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Praxis Health PCGroup PAC ID 8325941446, 174 clinicians

Practice addresses (Care Compare)

1130 W Prairie Ave
Coeur D Alene, ID 83815-8780
Phone 87770811193

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57250NMMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Praxis Health, PC CurrentSince Jan 1, 2023 Accepting new patients
Praxis Health, PC Family CurrentSince Jan 1, 2023 Accepting new patients
Grasshopper Natural Medicine PastSince Aug 1, 2019 Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1565136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648684800000",
    "number": "1750936522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 PASEO DE PERALTA",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011860",
            "telephone_number": "505-988-2449",
            "fax_number": "505-819-0588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 W PRAIRIE AVE",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158780",
            "telephone_number": "208-209-0288",
            "fax_number": "208-209-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUJAN",
        "first_name": "JESSICA",
        "credential": "APRN-CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-07",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "57250",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "71672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.