Active NPI
Hazel Healthcare LLC
- Nurse Practitioner
- Meridian, ID
National Provider Identifier
1962266403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- Legal business name
- HAZEL HEALTHCARE LLC
- Practice address
- 2584 N Stokesberry PL
Meridian, ID 83646-1144 - Phone
- (208) 906-2558
- NPI assigned
- Feb 6, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Laura D Carter
- Title
- Co-Owner/ Clinical Director
- Phone
- (208) 906-2558
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | Primary |
Addresses
Primary practice location
2584 N Stokesberry PL
Meridian, ID 83646-1144
Mailing address
2584 N Stokesberry PL
Meridian, ID 83646-1144
Phone (208) 906-2558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240226003360 | ID | Part B Supplier - Clinic/Group Practice | 2163867433 |
Receives reassigned benefits from 2 practitioners Practice locations: Meridian, ID |
National Provider Directory
National Provider Directory- Tax ID family
- Hazel Healthcare
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Primary Care Nurse Practitioner
- Meridian, ID
- NPI 1679355036
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707177600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1707177600000",
"number": "1962266403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2584 N STOKESBERRY PL",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836461144",
"telephone_number": "208-906-2558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2584 N STOKESBERRY PL",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836461144",
"telephone_number": "208-906-2558"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HAZEL HEALTHCARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-02-06",
"last_updated": "2024-02-06",
"certification_date": "2024-02-06",
"status": "A",
"authorized_official_last_name": "CARTER",
"authorized_official_first_name": "LAURA",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "CO-OWNER/ CLINICAL DIRECTOR",
"authorized_official_telephone_number": "208-906-2558"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.