Active NPI
Beverly Hanson, PA
- Surgical Physician Assistant
- Blackfoot, ID
National Provider Identifier
1003874389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PAG-012
- Practice address
- 98 Poplar St
Blackfoot, ID 83221-1758 - Phone
- (208) 782-3993
- Fax
- (208) 782-3994
- NPI assigned
- May 3, 2006
- Last updated
- Sep 9, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | PAG-012 | ID | Primary |
Addresses
Primary practice location
98 Poplar St
Blackfoot, ID 83221-1758
Mailing address
98 Poplar St
Blackfoot, ID 83221-1758
Phone (208) 782-3993
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HB405 | Other | ID | BLUE CROSS |
| PAJ80 | Other | ID | BCS LAMERE |
| 807338600 | Medicaid | ID | |
| HPAC6 | Other | ID | BLUE CROSS OLD |
| 000010154328 | Other | ID | REGENCE BLUE SHIELD |
| 000010167603 | Other | ID | RBS LAMERE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PAG-012 | ID | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ashton Memorial, Inc. | Past | Accepting new patients | |
| Medical Imaging Associates of Idaho Falls, Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
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- Pocatello, ID
- NPI 1740225531
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220918400000",
"number": "1003874389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98 POPLAR ST",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832211758",
"telephone_number": "208-782-3993",
"fax_number": "208-782-3994"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98 POPLAR ST",
"city": "BLACKFOOT",
"state": "ID",
"postal_code": "832211758",
"telephone_number": "208-782-3993",
"fax_number": "208-782-3994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSON",
"first_name": "BEVERLY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-03",
"last_updated": "2008-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "ID",
"license": "PAG-012",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "HB405",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCS LAMERE",
"identifier": "PAJ80",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807338600",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OLD",
"identifier": "HPAC6",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "000010154328",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RBS LAMERE",
"identifier": "000010167603",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blackfoot, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.