Jesse Alan Cottle, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1626 Issued in ID

Practice address

10583 W Lake Hazel Rd
Boise, ID 83709-6326

Phone

(208) 302-5950

Fax

(208) 302-5955

NPI assigned

Sep 13, 2018

Last updated

Sep 13, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jcottle170103@direct.slhs.org

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536796800000",
    "number": "1962985085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-5950",
            "fax_number": "208-302-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10583 W LAKE HAZEL RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837096326",
            "telephone_number": "208-302-5950",
            "fax_number": "208-302-5955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COTTLE",
        "first_name": "JESSE",
        "middle_name": "ALAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-13",
        "last_updated": "2018-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynnel Cote, LPC
• Brian E. Cothern, MD
• Rebekah Lynn Keturah Cotner, MSW, LSWAIC/LCSW
• Rebecca Cotterell, RN-BC, BSN
• Teri J Cottingham, M.D.
• Cottonwood Family Medicine
• Jennifer Cottrell, RD
• Couch Holistic Therapy, LLC
• Rachel E Couch, LCPC
• Brandon Lee Couchman, D.C.

• Physician Assistant in Boise, ID
• Providers in Boise, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.