Idaho Allergy & Asthma Clinic PA

Primary specialty

Allergy & Immunology PhysicianTaxonomy code 207K00000X

Legal business name

IDAHO ALLERGY & ASTHMA CLINIC PA

Practice address

3422 S 15TH E
Idaho Falls, ID 83404-8262

Phone

(208) 529-9292

Fax

(208) 523-2397

NPI assigned

Mar 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Wendell E Petty, M.D.NPI 1457312308

Title

President

Phone

(208) 529-9292

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wendell E Petty, M.D.

  • Allergy & Immunology Physician
  • Idaho Falls, ID
  • NPI 1457312308
  Medicare reassignment Care Compare group NPD Authorized official
• David Aaron Petty, D.O.

  • Allergy Physician
  • Idaho Falls, ID
  • NPI 1376877795

  Allergy & Immunology

  Medicare reassignment Care Compare group NPD
• Phillip Marlowe, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1760044424
  Medicare reassignment
• Jaden Juergens, PA-C

  • Physician Assistant
  • Layton, UT
  • NPI 1538810577

  ID

  Medicare reassignment

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561075200000",
    "number": "1003949298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3422 S 15TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048262",
            "telephone_number": "208-529-9292",
            "fax_number": "208-523-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3422 S 15TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048262",
            "telephone_number": "208-529-9292",
            "fax_number": "208-523-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO ALLERGY & ASTHMA CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2019-06-21",
        "status": "A",
        "authorized_official_last_name": "PETTY",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-529-9292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Allergy & Immunology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8N147",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DG4709",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0000100004631",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002516900",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Icare Optometry PLLC
• Id Behavioral Health, PLLC
• Id Dental Associates, P.C.
• Id Dept of Health & Welfare CSHP (HD6)
• Id Dept of Health & Welfare CSHP (HD7)
• Idaho Anesthesia Associates, PLLC
• Idaho Behavioral Health Services, LLC
• Idaho Department of Health & Welfare Region 7 Amh Clinic If
• Idaho Dept of Health & Welfare Esc Region 7
• Idaho Dept of Health & Welfare Itp Region 7

• Allergy & Immunology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Allergy & Immunology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.