NPIMap

Individual provider Active NPI

Richard A Wathne, MD

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Pocatello, ID
National Provider Identifier
1033296330
Registry record updated Sep 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
M6663 Issued in ID
Practice address
2240 E Center St
Pocatello, ID 83201-2600
Phone
(208) 233-2100
Fax
(208) 233-3146
NPI assigned
Nov 1, 2006
Last updated
Sep 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X M6663 ID Primary

Addresses

Primary practice location

2240 E Center St
Pocatello, ID 83201-2600

Mailing address

2240 E Center St
Pocatello, ID 83201-2600
Phone (208) 233-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051220000197 ID Practitioner - Orthopedic Surgery 2860397890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Rutgers New Jersey Medical School, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

2240 E Ctr St
Pocatello, ID 83201-2600
Phone (208) 233-2100

777 Hospital Way
Pocatello, ID 83201-5175

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement33
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)50

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M6663IDMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Health Services, LLC Sports Medicine CurrentSince Jan 1, 2022 Accepting new patients
Pocatello Health Services, LLC CurrentSince Jan 1, 2022 Accepting new patients
Pocatello Health Services, LLC Current Accepting new patients
Pocatello Hospital LLC Past Accepting new patients

Locations

2240 E Center St
Pocatello, ID 83201
Phone (208) 233-2100

333 N 18th Ave
Ste D1
Pocatello, ID 83201
Phone (208) 233-2100

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

Interoperability endpoints

  • Direct secure messaging: rwathne@direct.orthoida.com
  • Direct secure messaging: rwathne261943@ahs.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 5

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630972800000",
    "number": "1033296330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012600",
            "telephone_number": "208-233-2100",
            "fax_number": "208-233-3146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012600",
            "telephone_number": "208-233-2100",
            "fax_number": "208-233-3146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATHNE",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-09-07",
        "certification_date": "2021-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "ID",
            "license": "M6663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.