Jeffrey Arnold Kovnick, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

M-17191 Issued in ID

Practice address

PO Box 6106
Ketchum, ID 83340-6106

Phone

(801) 910-5822

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

Yes

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.

• Davis Behavioral Health Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Layton, UT
  • NPI 1770641672
  NPD (past)
• Ut-Tex, Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Magna, UT
  • NPI 1063552305
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Sep 30, 2024 through Sep 30, 2026

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 19, 2025.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742342400000",
    "number": "1770701609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6106",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833406106",
            "telephone_number": "801-910-5822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 6106",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833406106",
            "telephone_number": "801-910-5822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVNICK",
        "first_name": "JEFFREY",
        "middle_name": "ARNOLD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "UT",
            "license": "184995-1205",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "ID",
            "license": "M-17191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ketchum Family Medicine, PLLC
• Kimberly a Vorse MD PC
• Kimberly a. Vorse MD PC
• Koth Sports Physical Therapy, PA
• John C Koth, MPT
• David Laxson, M.D.
• Coleman Joshua Lay, OTR/L
• Allen Leavitt, PHARMD
• David Pierre Lederman, LMT
• Autumn M Loomis, MD

• All providers in Ketchum, ID
• Child & Adolescent Psychiatry Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.