NPIMap

Idaho State University

A Medicare group practice based in Pocatello, ID: 10 NPIs enrolled under one PECOS associate control ID (PAC ID 4688683030), with 40 clinicians.

Medicare enrollment

Medicare enrollment files
PAC ID
4688683030The PECOS associate control ID: one enrolled organization, which may hold several NPIs
Provider type
Part B Supplier - Clinic/Group Practice, Part B Supplier - Mass Immunization (Roster Biller Only)
Enrolled in
ID
Enrollments
2
Group size
19 cliniciansAs Care Compare reports it
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Practice locations
10In 7 places

Enrollment records 2

Enrollment IDStateProvider typeNPI
O20060412000292 ID Part B Supplier - Clinic/Group Practice 1952474777
O20210719001703 ID Part B Supplier - Mass Immunization (Roster Biller Only) 1497194013

NPIs in this group 10

NPPES NPI Registry

These NPI records belong to the same enrolled organization. Each has its own page.

Practice locations

Locations on the Medicare enrollment

Clinicians 40

Clinicians who reassign their Medicare benefits to this group (39) or whom Care Compare lists as members (19).

Sources for this page