Individual provider Active NPI

Sean E Cook

  • Gerontology Nurse Practitioner
  • Caldwell, ID
National Provider Identifier
1891310892
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
64857 Issued in ID
Practice address
211 E Logan St
Caldwell, ID 83605-4882
Phone
(208) 963-1871
NPI assigned
Jun 15, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 64857 ID Primary

Addresses

Primary practice location

211 E Logan St
Caldwell, ID 83605-4882

Mailing address

1743 N Windsor Park CT
Middleton, ID 83644-5672
Phone (208) 965-3517

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201008003187 ID Practitioner - Nurse Practitioner 8921428152 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Valley Medical Associates IncGroup PAC ID 9931467289, 28 clinicians

Practice addresses (Care Compare)

1717 Arlington Ave
Caldwell, ID 83605-4802
Phone (208) 455-3917

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64857IDMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
West Valley Medical Group LLC PastSince Jun 21, 2020 Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1592179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1891310892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1743 N WINDSOR PARK CT",
            "city": "MIDDLETON",
            "state": "ID",
            "postal_code": "836445672",
            "telephone_number": "208-965-3517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 E LOGAN ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054882",
            "telephone_number": "208-963-1871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "SEAN",
        "middle_name": "E",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-15",
        "last_updated": "2025-09-11",
        "certification_date": "2020-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "ID",
            "license": "64857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

Verify at the official NPI Registry.