Jamie Tisa Coffey-Kelly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW-37639 Issued in ID

Practice address

402 Lake Cascade Pkwy
Cascade, ID 83611-7702

Phone

(208) 382-4285

Fax

(208) 382-5081

NPI assigned

Nov 13, 2013

Last updated

Feb 22, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16522/brand/1/csg/1/fhir/r4

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.

• Glenns Ferry Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Glenns Ferry, ID
  • NPI 1376673137
  Medicare reassignment NPD
• Kelly Companies, LLC

  dba Mountain Valley Counseling & Outdoor Therapy

  • Clinical Social Worker
  • Donnelly, ID
  • NPI 1487310074
  NPD Authorized official
• Glenns Ferry Health Center, Inc.

  dba Desert Sage Health Centers

  • Federally Qualified Health Center (FQHC)
  • Mountain Home, ID
  • NPI 1518097047
  NPD
• Glenns Ferry Health Center, Inc.

  dba Desert Sage Health Centers

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mountain Home, ID
  • NPI 1881252344
  NPD

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1992135818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1330",
            "city": "CASCADE",
            "state": "ID",
            "postal_code": "836111330",
            "telephone_number": "208-382-4285",
            "fax_number": "208-382-5081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 LAKE CASCADE PKWY",
            "city": "CASCADE",
            "state": "ID",
            "postal_code": "836117702",
            "telephone_number": "208-382-4285",
            "fax_number": "208-382-5081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COFFEY-KELLY",
        "first_name": "JAMIE",
        "middle_name": "TISA",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-13",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-37639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cascade Medical Center
• Cascade Medical Center Hospital District
• Cascade Medical Center Hospital District
• Cascade Rural Fire Protection District (Cascade Rural Fire & EMS)
• Cascade School District #422
• Cornerstone Family & Cosmetic Dentistry
• Gayle Eaton, LCSW
• Ronald K Ellsworth, MD
• Katherine Farmer, TDPT
• Katherine Louise Ferguson, FNP

• Clinical Social Worker in Cascade, ID
• Providers in Cascade, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2021; 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.