NPIMap

Individual provider Active NPI

Jean K Thomas, MD

  • Neurology Physician
  • Lewiston, ID
National Provider Identifier
1881695534
Registry record updated Dec 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
M-12101 Issued in ID
Practice address
415 6TH St
Lewiston, ID 83501-2431
Phone
(208) 750-7474
Fax
(208) 799-5729
NPI assigned
Aug 3, 2005
Last updated
Dec 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X L2777 TX
Neurology Physician 2084N0400X M-12101 ID Primary

Addresses

Primary practice location

415 6TH St
Lewiston, ID 83501-2431

Mailing address

415 6TH Street
Attn: Physician Services
Lewiston, ID 83501-2424
Phone (208) 750-7462

Other practice location 1

2202 Via Del Norte Cir
Carrollton, TX 75006-2839
Phone (208) 750-7474

Other identifiers 3

IdentifierTypeStateIssuer
151672601MedicaidTX
151672601MedicaidAR
1881695534MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100114000086 TX Practitioner - Neurology 1951442896 Reassigns benefits to 1 organization
I20130912000830 ID Practitioner - Neurosurgery 1951442896 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Arkansas College of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Joseph Hospital LLCGroup PAC ID 8325325806, 91 clinicians

Practice addresses (Care Compare)

307 Saint Johns Way
Suite 1
Lewiston, ID 83501-2435
Phone (208) 743-3998

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
L2777TXMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Collom & Carney Clinic Association Current Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
St Joseph Hospital LLC CurrentSince May 1, 2017 Accepting new patients
Collom & Carney Clinic Association Current Accepting new patients
St. Joseph Hospital LLC Past Accepting new patients
Kootenai Health, Inc. Past Accepting new patients
Affiliated Neurologists PLLC Neurology Past Accepting new patients

Locations

307 Saint Johns Way
Ste 1
Lewiston, ID 83501
Phone (208) 743-3998

307 Saint Johns Way
Ste 17
Lewiston, ID 83501
Phone (208) 746-7055

341 Saint Johns Way
Lewiston, ID 83501
Phone (208) 750-7462

415 6th St
Lewiston, ID 83501
Phone (208) 750-7445

821 21st Ave
Lewiston, ID 83501
Phone (208) 799-3422

5002 Cowhorn Creek Rd
Texarkana, TX 75503
Phone (903) 614-3008

Interoperability endpoints

  • Direct secure messaging: jean.thomas.1@16883.direct.athenahealth.com

Organizations & group practices 7

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735171200000",
    "number": "1881695534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH STREET",
            "address_2": "ATTN: PHYSICIAN SERVICES",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012424",
            "telephone_number": "208-750-7462",
            "fax_number": "208-750-7467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-750-7474",
            "fax_number": "208-799-5729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2202 Via Del Norte Cir",
            "address_purpose": "LOCATION",
            "city": "Carrollton",
            "state": "TX",
            "postal_code": "750062839",
            "country_code": "US",
            "telephone_number": "208-750-7474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "JEAN",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-03",
        "last_updated": "2024-12-26",
        "certification_date": "2024-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "TX",
            "license": "L2777",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ID",
            "license": "M-12101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151672601",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151672601",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881695534",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.