NPIMap

Individual provider Active NPI

Tiana Jespersen Nizamic, MD

  • Nephrology Physician
  • Coeur d'Alene, ID
National Provider Identifier
1891182911
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
M-15908 Issued in ID
Practice address
700 W Ironwood Dr Ste 375
Coeur D Alene, ID 83814-4401
Phone
(208) 625-6100
Fax
(208) 625-6101
NPI assigned
Apr 16, 2015
Last updated
May 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X M-15908 ID Primary

Addresses

Primary practice location

700 W Ironwood Dr Ste 375
Coeur D Alene, ID 83814-4401

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-6100

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tjespersennizamic610253@direct.multicare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, 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
I20200910003241 CA Practitioner - NephrologyPractitioner - Internal Medicine 3274827316 Reassigns benefits to 1 organization
I20210903001833 ID Practitioner - Nephrology 3274827316 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Washington School of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kootenai Health IncGroup PAC ID 1355792276, 394 clinicians

Practice addresses (Care Compare)

1055 Riverside Ave
Orofino, ID 83544-9029
Phone (208) 476-5777

1300 E Mullan Ave
Suite 1300
Post Falls, ID 83854-6057
Phone (208) 625-5630

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051

2100 Ironwood CT
Coeur D Alene, ID 83814-2698
Phone (208) 625-6100

2120 W Ironwood Dr
Coeur D Alene, ID 83814-2698
Phone (208) 625-6939

600 N Cecil Rd
Post Falls, ID 83854-6200
Phone (208) 262-2800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as apm
Quality
89.26
Promoting interoperability
69.9
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-15908IDMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca Current Accepting new patients
Kootenai Health, Inc. CurrentSince Sep 30, 2021 Accepting new patients
Kootenai Health, Inc. Current Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Incyte Pathology, LLC Current Accepting new patients
Regents of the Univ of Ca CurrentSince Jul 1, 2020 Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Regents of the University of Ca Nephrology CurrentSince Jul 1, 2020 Accepting new patients
Kootenai Health, Inc. CurrentSince Sep 30, 2021 Accepting new patients

Locations

4860 Y St
Sacramento, CA 95817
Phone (916) 734-2700

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

700 W Ironwood Dr
Ste 375
Coeur D Alene, ID 83814
Phone (208) 625-5085

1300 E Mullan Ave
Ste 700
Post Falls, ID 83854
Phone (208) 625-5564

Interoperability endpoints

  • Direct secure messaging: tjespersennizamic610253@direct.multicare.org

Organizations & group practices 9

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 9

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": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1891182911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-6100",
            "fax_number": "208-625-6101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 W IRONWOOD DR STE 375",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838144401",
            "telephone_number": "208-625-6100",
            "fax_number": "208-625-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JESPERSEN NIZAMIC",
        "first_name": "TIANA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-16",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "ID",
            "license": "M-15908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tjespersennizamic610253@direct.multicare.org",
            "affiliation": "N",
            "address_1": "700 W Ironwood Dr Ste 375",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838144401",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.