Individual provider Active NPI

Daniel Scott Johnson

  • Certified Registered Nurse Anesthetist
  • Twin Falls, ID
National Provider Identifier
1013774868
Registry record updated May 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
78095 Issued in ID
Practice address
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone
(208) 734-7362
Fax
(208) 814-0948
NPI assigned
Feb 28, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 78095 ID Primary
Certified Registered Nurse Anesthetist 367500000X 209.035607 IL

Addresses

Primary practice location

801 Pole Line Rd W
Twin Falls, ID 83301-5810

Mailing address

2024 Blue Sky LN
Twin Falls, ID 83301-5558

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240410003021 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274971106 Reassigns benefits to 1 organization
I20260527002419 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274971106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone (208) 814-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
78095IDMDCertified Registered Nurse Anesthetist
209.035607ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Clinic LLC CurrentSince Mar 18, 2024 Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

801 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1709078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778803200000",
    "number": "1013774868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2024 BLUE SKY LN",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 POLE LINE RD W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015810",
            "telephone_number": "208-734-7362",
            "fax_number": "208-814-0948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DANIEL",
        "middle_name": "SCOTT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-28",
        "last_updated": "2026-05-15",
        "certification_date": "2026-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "78095",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209.035607",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.