NPIMap

Individual provider Active NPI

Leonard Jensen, FNP

  • Family Nurse Practitioner
  • Eagle, ID
National Provider Identifier
1851604904
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201050116NP Issued in OR
Practice address
1159 E Iron Eagle Dr
Eagle, ID 83616-6871
Phone
(208) 209-3242
Fax
(208) 549-7880
NPI assigned
Jul 19, 2010
Last updated
Dec 9, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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 201050116NP OR Primary
Family Nurse Practitioner 363LF0000X NP1166A ID

Addresses

Primary practice location

1159 E Iron Eagle Dr
Eagle, ID 83616-6871

Mailing address

1159 E Iron Eagle Dr
Eagle, ID 83616-6871
Phone (208) 209-3242

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120820000613 ID Practitioner - Nurse Practitioner 0042223687 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Key Stone Health CareGroup PAC ID 0648402784, 6 clinicians
Keystone Center for Geriatrics LLCGroup PAC ID 7618365792, 8 clinicians

Practice addresses (Care Compare)

21 N Fisher Park Way
Eagle, ID 83616-4796
Phone (208) 514-0670

305 W Bannock St
Boise, ID 83702-6033
Phone (208) 514-0670

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NP1166AIDMDFamily Nurse Practitioner
201050116NPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Keystone Center for Geriatrics LLC CurrentSince Oct 1, 2021 Accepting new patients
Marion Luque,PLLC CurrentSince Oct 1, 2021 Accepting new patients
Key Stone Health Care CurrentSince Jan 1, 2014 Accepting new patients
Keystone Hospice, LLC CurrentSince Aug 11, 2019 Accepting new patients
Serenity Palliative Care and Hospice, LLC PastSince Apr 29, 2011 Accepting new patients

Locations

305 W Bannock St
Boise, ID 83702
Phone (208) 514-0670

1139 E Winding Creek Dr
Eagle, ID 83616
Phone (208) 938-8887

21 N Fisher Park Way
Eagle, ID 83616
Phone (208) 514-0670

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Keystone Hospice, LLCEagle, ID, CCN 131574 Hospice 5% Or Greater Direct Ownership Interest (25%)
Corporate Officer (50%)
Corporate Director (50%)
W-2 Managing Employee (100%)		 Oct 13, 2015
Oct 13, 2015
Oct 13, 2015
Oct 13, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Keystone Hospice, LLC
    • Community Based Hospice Care Agency
    • Eagle, ID
    • NPI 1427421114

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Organizations & group practices 6

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 10

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": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418083200000",
    "number": "1851604904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1159 E IRON EAGLE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166871",
            "telephone_number": "208-209-3242",
            "fax_number": "208-549-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1159 E IRON EAGLE DR",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166871",
            "telephone_number": "208-209-3242",
            "fax_number": "208-549-7880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "LEONARD",
        "name_prefix": "Mr.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-19",
        "last_updated": "2014-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201050116NP",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP1166A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.