NPIMap

Individual provider Active NPI

Jennifer Petrie, MD

  • Family Medicine Physician
  • Emmett, ID
National Provider Identifier
1891879094
Registry record updated Feb 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M7802 Issued in ID
Practice address
2001 E Quail Run Rd
Emmett, ID 83617-5059
Phone
(208) 365-7131
Fax
(208) 365-4464
NPI assigned
Oct 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M7802 ID Primary
Family Medicine Physician 207Q00000X 101703 MN

Addresses

Primary practice location

2001 E Quail Run Rd
Emmett, ID 83617-5059

Mailing address

2001 E Quail Run Rd
Emmett, ID 83617-5059
Phone (208) 365-7131

Other identifiers 11

IdentifierTypeStateIssuer
136314OtherMNUCARE
HP51751OtherMNHEALTH PARTNERS
8051964MedicaidID
1043689OtherMNPREFERRED ONE
317180900MedicaidMN
34623200MedicaidWI
01-20325OtherMNMEDICA CHOICE
01-20325OtherMNMEDICA PRIMARY
0591172MedicaidIA
20008330OtherIDPTAN
2349340OtherMTARAZ

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
I20050215000756 ID Practitioner - Family Practice 3072583582 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2001 E Quail Run Rd
Emmett, ID 83617-5059
Phone (208) 365-7131

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Valor Health Hospital, Emmett, ID, CCN 131318
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M7802IDMDFamily Medicine Physician
101703MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Benewah Community Hospital Family Medicine Current Accepting new patients
Petrie White Family Medicine of Idaho Family Medicine CurrentSince Oct 21, 2015 Accepting new patients
Orthopedic & Fracture Clinic PA PastSince Oct 21, 2015 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients
Inland Empire Hospital Services Association Family Medicine Past Accepting new patients

Locations

2001 E Quail Run Rd
Emmett, ID 83617
Phone (208) 365-7131

229 S 8th St
St Maries, ID 83861
Phone (208) 245-2591

229 S 7th St
St Maries, ID 83861
Phone (208) 245-2591

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/e8b4f872-6ea1-4b26-a974-041b5fb4c57b/
  • Direct secure messaging: jpetrie@yourcarecommunity.org

Organizations & group practices 5

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 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": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456185600000",
    "number": "1891879094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 E QUAIL RUN RD",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836175059",
            "telephone_number": "208-365-7131",
            "fax_number": "208-365-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 E QUAIL RUN RD",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836175059",
            "telephone_number": "208-365-7131",
            "fax_number": "208-365-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIE",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-24",
        "last_updated": "2016-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7802",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "101703",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "136314",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP51751",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8051964",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1043689",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "317180900",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34623200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "01-20325",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PRIMARY",
            "identifier": "01-20325",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0591172",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "20008330",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ",
            "identifier": "2349340",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Emmett, ID

Sources for this page

Verify at the official NPI Registry.