NPIMap

Individual provider Active NPI

Jack Casteel Bruner II, MD

  • Family Medicine Physician
  • Cottonwood, ID
National Provider Identifier
1982607669
Registry record updated Aug 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M6055 Issued in ID
Practice address
701 Lewiston St
Cottonwood, ID 83522-9750
Phone
(208) 962-3267
Fax
(208) 962-2313
NPI assigned
May 24, 2005
Last updated
Aug 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X M6055 ID
Family Medicine Physician 207Q00000X M6055 ID Primary

Addresses

Primary practice location

701 Lewiston St
Cottonwood, ID 83522-9750

Mailing address

PO Box 565
Cottonwood, ID 83522-0565
Phone (208) 962-3267

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
I20050706001048 ID Practitioner - Family PracticePractitioner - Sports Medicine 4981640497 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
University of Kentucky College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Marys Hospital IncGroup PAC ID 5092773168, 22 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as apm
Quality
89.26
Promoting interoperability
69.9
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M6055IDMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary's Hospital Inc Family Medicine CurrentSince Jun 28, 2005 Accepting new patients
St. Mary's Hospital Inc CurrentSince Jun 28, 2005 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

  • Direct secure messaging: jackbruner@smhcvhc.medalliesdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1982607669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 565",
            "city": "COTTONWOOD",
            "state": "ID",
            "postal_code": "835220565",
            "telephone_number": "208-962-3267",
            "fax_number": "208-962-2313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 LEWISTON ST",
            "city": "COTTONWOOD",
            "state": "ID",
            "postal_code": "835229750",
            "telephone_number": "208-962-3267",
            "fax_number": "208-962-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNER",
        "first_name": "JACK",
        "middle_name": "CASTEEL",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M6055",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M6055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cottonwood, ID

Sources for this page

Verify at the official NPI Registry.