NPIMap

Organization Active NPI

Kootenai Health, Inc.

  • General Acute Care Hospital
  • Coeur d'Alene, ID
National Provider Identifier
1992798409
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
42 Issued in 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
Last updated
Jan 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Authorized official

Name
Jon Ness
Title
Ceo
Phone
(208) 625-5081

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 42 ID Primary

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 3

IdentifierTypeStateIssuer
00257OtherIDBLUE CROSS
002292400MedicaidID
000010004925OtherIDBLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992798409. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jul 27, 1983 in ID
Enrollment address
2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Kootenai HealthCCN 130049 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Kootenai Health Inc9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

700 W Ironwood Dr
Ste 375
Coeur D Alene, ID 83814
Phone (208) 625-5085

1300 E Mullan Ave
Ste 900
Post Falls, ID 83854
Phone (208) 625-5530

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cindy Clark Individual Corporate Director May 1, 2023
Thomas R Detar Individual Corporate Director May 1, 2023
Katie Brodie Individual Corporate Director May 1, 2023
Steven Matheson Individual Corporate Director May 1, 2023
Lisa L. Goodwin Individual W-2 Managing EmployeeDirector Medical Staff Services May 1, 2023
Michele Bouit Individual Operational/Managerial ControlCfo Mar 11, 2024
Robert Colvin Individual Corporate Director May 1, 2023
Robert M McFarland Individual Corporate Director May 1, 2023
Teri Farr Individual Corporate Director May 1, 2023
Elizabeth Godbehere Individual Corporate Director May 1, 2023

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 126

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 126

Affiliated clinicians 956

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 956

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1992798409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOOTENAI HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "NESS",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-625-5081"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "ID",
            "license": "42",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00257",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002292400",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010004925",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.