Jack Casteel Bruner II, MD
Individual provider Active NPI Family Medicine Physician · Cottonwood, ID
NPI 1982607669 · NPPES record last updated Aug 6, 2021
Key facts
- NPI
- 1982607669
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M6055 (ID)
- Practice address
- 701 Lewiston St
Cottonwood, ID 83522-9750 - Phone
- (208) 962-3267
- Fax
- (208) 962-2313
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 17
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Kentucky College of Medicine, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Marys Hospital Inc
Practice addresses (Care Compare)
701 Lewiston St
Cottonwood, ID 83522-9750
Phone (208) 962-3251
Hospital & facility affiliations
- Syringa General Hospital Hospice
- St Mary'S Hospital
- Syringa General Hospital
- St Joseph Regional Medical Center
- Clearwater Valley Hospital & Clinics
- Grangeville Health & Rehabilitation of Cascadia
- St Mary'S Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.65 of 100
- Quality
- 89.26
- Promoting interoperability
- 69.9
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050706001048 | ID | Practitioner - Family Practice |
4981640497 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M6055 | ID | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Mary'S Hospital Inc | Current |
Accepting new patients | |
| St. Mary'S Hospital Inc | Family Medicine | Current |
Accepting new patients |
| St. Mary'S Hospital Inc | Family Medicine | Past | Accepting new patients |
| St. Mary'S Hospital Inc | Family Medicine | Past | Accepting new patients |
Locations
701 Lewiston St
Cottonwood, ID 83522
Phone (208) 962-3251
501 Oak St
Nezperce, ID 83543
Phone (208) 937-2496
Interoperability endpoints
- jackbruner@smhcvhc.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | M6055 | ID | |
| Family Medicine Physician | 207Q00000X | M6055 | ID | Yes |
Addresses
Primary practice location
701 Lewiston St
Cottonwood, ID 83522-9750
Mailing address
PO Box 565
Cottonwood, ID 83522-0565
Phone (208) 962-3267
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002283800 | Medicaid | ID |
Other providers in Cottonwood, ID
- Rod F. Arnzen
- John Beeh
- Vicki Lynne Berg
- Barry J Bergen
- Briana Sarah Bowden
- Cottonwood JT SCH Dist
- Cottonwood Physical Therapy, PLLC
- Cottonwood Shelter Home Inc
- Margaret A Gehring
- Bryan Leon Gimmeson
All providers in Cottonwood, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.