Active NPI
Kathleen Egan Haisley, MD
- Family Medicine Physician
- Ketchum, ID
National Provider Identifier
1821039017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M6381
- Practice address
- 100 Hospital Drive
Ketchum, ID 83340 - Phone
- (208) 727-8100
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M6381 | ID | Primary |
Addresses
Primary practice location
100 Hospital Drive
Ketchum, ID 83340
Mailing address
PO Box 100
Ketchum, ID 83340-0100
Phone (208) 727-8100
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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M6381 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Clinic LLC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149811200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1197849600000",
"number": "1821039017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 100",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833400100",
"telephone_number": "208-727-8100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 HOSPITAL DRIVE",
"city": "KETCHUM",
"state": "ID",
"postal_code": "83340",
"telephone_number": "208-727-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAISLEY",
"first_name": "KATHLEEN",
"middle_name": "EGAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-09",
"last_updated": "2007-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M6381",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ketchum, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.