NPIMap

Individual provider Active NPI

Jeremy Robert Nicolarsen, MD

  • Pediatric Cardiology Physician
  • Coeur D Alene, ID
National Provider Identifier
1891946778
Registry record updated Oct 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
M13579 Issued in ID
Practice address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone
(208) 625-4000
NPI assigned
Oct 9, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X M13579 ID Primary

Addresses

Primary practice location

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

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID, MT3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20160808002023 WA Practitioner - Cardiovascular Disease (Cardiology) 3971746496 Reassigns benefits to 2 organizations
I20170403001969 ID Practitioner - Cardiovascular Disease (Cardiology) 3971746496 Reassigns benefits to 3 organizations
I20180321001408 MT Practitioner - Cardiovascular Disease (Cardiology) 3971746496 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
University of Chicago, Pritzker School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians
Providence Health and Services WashingtonGroup PAC ID 8729258256, 53 clinicians

Practice addresses (Care Compare)

101 W 8TH Ave
Spokane, WA 99204-2307

112 Columbia Point Dr
Suite 103
Richland, WA 99352-4390
Phone (509) 942-2766

1200 E Columbia Ave
Colville, WA 99114-3354
Phone (509) 684-3701

500 W Broadway St
Suite 320
Missoula, MT 59802-4003
Phone (406) 329-5615

701 Lewiston St
Cottonwood, ID 83522-9750
Phone (208) 962-3251

714 W Pine St
Newport, WA 99156-9046
Phone (509) 447-2441

825 SE Bishop Blvd
Suite 140
Pullman, WA 99163-5517
Phone (509) 455-8820

982 E Columbia Ave
Colville, WA 99114-3316
Phone (509) 685-5100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M13579IDMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kootenai Health, Inc. CurrentSince Mar 10, 2024 Accepting new patients
Kootenai Health, Inc. CurrentSince Jul 14, 2017 Accepting new patients
Providence Health & Services Washington CurrentSince Aug 1, 2016 Accepting new patients
Providence Health & Services Mt CurrentSince Apr 1, 2018 Accepting new patients
Kootenai Health, Inc. CurrentSince Mar 10, 2024 Accepting new patients
St Patrick Hosp and Health Sci Ctr CurrentSince Apr 1, 2018 Accepting new patients
Kootenai Health, Inc. Current Accepting new patients
Providence Health & Services Mt Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

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

701 Lewiston St
Cottonwood, ID 83522
Phone (208) 962-3251

2315 8th St Grade
Lewiston, ID 83501
Phone (208) 746-1383

619 S Washington St
Ste 201
Moscow, ID 83843
Phone (208) 882-1777

700 S Main St
Moscow, ID 83843
Phone (208) 746-7555

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

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

1200 E Columbia Ave
Colville, WA 99114
Phone (509) 684-3701

825 SE Bishop Blvd
Ste 140
Pullman, WA 99163
Phone (509) 334-4498

112 Columbia Point Dr
Ste 103
Richland, WA 99352
Phone (509) 747-6707

101 W 8th Ave
Ste 4300
Spokane, WA 99204
Phone (509) 474-6707

55 W Tietan St
Walla Walla, WA 99362
Phone (509) 525-3720

Interoperability endpoints

  • Direct secure messaging: jnicolarsen623308@wm.providencedirect.org

Organizations & group practices 11

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 8

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": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601596800000",
    "number": "1891946778",
    "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": "208-625-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICOLARSEN",
        "first_name": "JEREMY",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-09",
        "last_updated": "2020-10-02",
        "certification_date": "2020-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "ID",
            "license": "M13579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.