NPIMap

Organization Active NPI

Teton Radiology Diagnostic a Series of Teton Group Enterprise

  • Body Imaging Physician
  • Idaho Falls, ID
National Provider Identifier
1013085604
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Body Imaging PhysicianTaxonomy code 2085B0100X
Legal business name
TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE
Practice address
2001 S Woodruff Ave Ste 17
Idaho Falls, ID 83404-6372
Phone
(208) 524-7237
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Authorized official

Name
Mr. Michael P Hodel
Title
General Manager
Phone
(208) 542-5000

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X Primary
Neuroradiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0700X
Nuclear Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0904X
Pediatric Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085P0229X
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Therapeutic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0203X
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Radiological Physics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0205X
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X

Addresses

Primary practice location

2001 S Woodruff Ave Ste 17
Idaho Falls, ID 83404-6372

Mailing address

PO Box 30015
Dept 594
Salt Lake City, UT 84130-0015
Phone (800) 475-6236

Other identifiers 2

IdentifierTypeStateIssuer
807617900MedicaidID
DF6608OtherRAILROAD MEDICARE

Other names 2

  • Teton Radiology Doing business as
  • Teton Radiology Diagnostic LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, MT, UT, WY, TX, NV, OH7 enrollments

Enrollment records 7

Enrollment IDStateProvider typePAC IDDetails
O20070424000540 ID Part B Supplier - Clinic/Group Practice 1254436959 Receives reassigned benefits from 43 practitioners
Practice locations: Pocatello, ID; Idaho Falls, ID; Preston, ID; Rexburg, ID; Rupert, ID; Salmon, ID; Sandpoint, ID; Soda Springs, ID…
O20231127000362 MT Part B Supplier - Clinic/Group Practice 1254436959 Receives reassigned benefits from 31 practitioners
Practice locations: Deer Lodge, MT
O20231127001700 UT Part B Supplier - Clinic/Group Practice 1254436959 Receives reassigned benefits from 24 practitioners
Practice locations: Lehi, UT; Park City, UT; Providence, UT
O20231221003308 WY Part B Supplier - Clinic/Group Practice 1254436959 Receives reassigned benefits from 31 practitioners
Practice locations: Lander, WY; Rock Springs, WY; Riverton, WY; Rawlins, WY; Auburn, WY; Afton, WY
O20240726000770 TX Part B Supplier - Clinic/Group Practice 1254436959 Receives reassigned benefits from 2 practitioners
Practice locations: Corpus Christi, TX; Vidor, TX
O20260128004140 NV Part B Supplier - Clinic/Group Practice 1254436959 Receives reassigned benefits from 2 practitioners
Practice locations: Henderson, NV; Las Vegas, NV
O20260514003420 OH Part B Supplier - Clinic/Group Practice 1254436959 Receives reassigned benefits from 1 practitioner
Practice locations: Dublin, OH

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

1441 Parkway Dr
Rm T9
Blackfoot, ID 83221
Phone (208) 785-2600

2001 S Woodruff Ave
Idaho Falls, ID 83404
Phone (208) 523-2060

711 Rigby Lake Dr
Rigby, ID 83442
Phone (208) 745-0315

Practitioners & affiliated clinicians

Practitioners 49

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

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1013085604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30015",
            "address_2": "DEPT 594",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300015",
            "telephone_number": "800-475-6236",
            "fax_number": "706-596-6712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 17",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046372",
            "telephone_number": "208-524-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON RADIOLOGY DIAGNOSTIC A SERIES OF TETON GROUP ENTERPRISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A",
        "authorized_official_last_name": "HODEL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "208-542-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085P0229X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Pediatric Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Therapeutic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0205X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiological Physics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807617900",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF6608",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Teton Radiology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Teton Radiology Diagnostic LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2026; 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.