Kootenai Health, Inc.
Organization Active NPI General Acute Care Hospital · Coeur D Alene, ID
NPI 1992798409 · NPPES record last updated Jan 2, 2024
Key facts
- NPI
- 1992798409
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 42 (ID)
- Legal business name
- KOOTENAI HEALTH, INC.
- Practice address
- 2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051 - Phone
- (208) 625-4000
- NPI assigned
- Aug 30, 2005
- Organization subpart
- No
Authorized official
- Name
- Jon Ness
- Title
- Ceo
- Phone
- (208) 625-5081
Owners & managing parties with NPI records 1
-
Thomas R Detar, M.D., F.A.C.S.
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 1
Corporate family (same tax ID) 8
Practitioners 420
-
Annette L Asper, DNP
-
Eliessa Bell, MD
-
Rebecca Joy Bertsch, D.O.
-
Taffie L Bowman, RN, BSN, MSN, ARNP
-
Marquita Brooks, PA-C
-
Robert J Burnett, M.D.
-
Aaron J Chalmers, M.D.
-
Kevin J Chang, M.D.
-
Laurel Cope, PA-C
-
Christina Crabtree, M.D.
-
Charles Qiming Cui, M.D.
-
Bryan L Davidson, MD
-
Sarah Derrig, NP
-
Bradley C Drury, M.D.
-
Philip Gardner, MD
-
Brandon Greene, D.O.
-
Magdelena Greene, MD
Affiliated clinicians 956
-
Jessica A Adams, PA-C
-
Jonathan T Adams, P.A.-C
-
Lindsay Marie Adams, ARNP
-
Kate Aguirre, M.D.
-
Natalya Alekhina, ARNP
-
Uzochukwu Amadi, MD
-
Marissa Armstrong, DNP, FNP-C
-
Katelin Nicole Arnold, DNP, APRN, FNP-C
-
Annette L Asper, DNP
-
Amanda J Austin, PA-C
-
Ryan Kenneth Averett, D.P.M.
-
Tara Dawn Avriett, ARNP
-
Stephen F Ayers, CRNA
-
Rachel Elaine Bagley, FNP-BC
Medicare Care Compare: Hospital
- Listed as
- Kootenai Health
- Overall star rating
- ★★★★☆ 4 of 5
- Type
- Acute Care Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in ID
Hospital certification: CCN 130049
- Legal name
- KOOTENAI HEALTH INC
- Doing business as
- KOOTENAI HEALTH
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Dec 22, 1966
- Last certification
- Nov 1, 2019
- Beds
- 321
- Ownership / control type
- Hospital district or authority
- Most recent change of ownership
- Jan 1, 2024 (3 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 27, 1983 in ID
- Enrollment address
- 2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Cindy Clark |
Corporate Director | May 1, 2023 | |
| Thomas R Detar |
Corporate Director | May 1, 2023 | |
| Katie Brodie |
Corporate Director | May 1, 2023 | |
| Steven Matheson |
Corporate Director | May 1, 2023 | |
| Lisa L. Goodwin |
W-2 Managing Employee |
May 1, 2023 | |
| Michele Bouit |
Operational/Managerial Control |
Mar 11, 2024 | |
| Robert Colvin |
Corporate Director | May 1, 2023 | |
| Robert M McFarland |
Corporate Director | May 1, 2023 | |
| Teri Farr |
Corporate Director | May 1, 2023 | |
| Elizabeth Godbehere |
Corporate Director | May 1, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041214000230 | ID | Part B Supplier - Clinic/Group Practice | 4789641598 |
Receives reassigned benefits from 359 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cottonwood, ID; Grangeville, ID; Kellogg, ID; Lewiston, ID; Moscow, ID; Orofino, ID; Post Falls, ID; Saint Maries, ID… |
| O20240104003340 | ID | Part a Provider - Hospital | 1355792276 | |
| O20240111003252 | ID | Part B Supplier - Clinic/Group Practice | 1355792276 |
Receives reassigned benefits from 526 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cottonwood, ID; Coeur D Alene, ID; Grangeville, ID; Kellogg, ID; Lewiston, ID; Moscow, ID; Orofino, ID; Post Falls, ID… |
National Provider Directory
- Tax ID family
- Kootenai Health Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 42 | ID | Yes |
Addresses
Primary practice location
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Mailing address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002292400 | Medicaid | ID | |
| 00257 | Other | ID | BLUE CROSS |
| 000010004925 | Other | ID | BLUE SHIELD |
Other providers in Coeur D Alene, ID
- Kootenai Health, Inc.
- Kootenai Health, Inc.
- Kootenai Health, Inc.
- Kootenai Health, Inc.
- Kootenai Health, Inc.
- Kootenai Surgery Associates PLLC
- Kootenai Urgent Care LLC
- Kootenai Urgent Care LLC
- Kootenai Urgent Care, LLC
- Kootenai Vision, PLLC
All providers in Coeur D Alene, ID · General Acute Care Hospital in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2024. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- 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.