NPIMap

Organization Active NPI

Jump Start Pediatrics

  • Supports Brokerage Agency
  • Coeur d'Alene, ID
National Provider Identifier
1881072817
Registry record updated May 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Supports Brokerage AgencyTaxonomy code 251X00000X
License
OT-1455 Issued in ID
Legal business name
JUMP START PEDIATRICS
Practice address
411 W Haycraft Ave Ste D4
Coeur D Alene, ID 83815-8104
Phone
(206) 664-2468
NPI assigned
May 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2015

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

Authorized official

Name
Becca Fahey
Title
Office Manager
Phone
(208) 664-2468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Supports Brokerage Agency 251X00000X OT-1455 ID Primary

Addresses

Primary practice location

411 W Haycraft Ave Ste D4
Coeur D Alene, ID 83815-8104

Mailing address

411 W Haycraft Ave Ste D4
Coeur D Alene, ID 83815-8104

National Provider Directory

National Provider Directory

Locations

411 W Haycraft Ave
Ste D4
Coeur D Alene, ID 83815
Phone (208) 644-2468

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431302400000",
    "number": "1881072817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W HAYCRAFT AVE STE D4",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W HAYCRAFT AVE STE D4",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158104",
            "telephone_number": "206-664-2468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUMP START PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-11",
        "last_updated": "2015-05-11",
        "status": "A",
        "authorized_official_last_name": "FAHEY",
        "authorized_official_first_name": "BECCA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-664-2468"
    },
    "taxonomies": [
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": "ID",
            "license": "OT-1455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.