Idaho Sports & Spine PLLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

O-0400 Issued in ID

Legal business name

IDAHO SPORTS & SPINE PLLC

Practice address

950 Hospital Way
Ste a
Pocatello, ID 83201-2789

Phone

(208) 478-4522

Fax

(208) 478-2935

NPI assigned

Mar 1, 2011

Organization subpart

No

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

Authorized official

Name

Stephen Hansen, D.O.NPI 1164491460

Title

Owner

Phone

(208) 478-4522

Specialties & licenses 1

Addresses

Other names 1

• Christopher R Johnson DO, PLLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

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

• Stephen M Hansen, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Pocatello, ID
  • NPI 1164491460
  Medicare reassignment Care Compare group NPD Authorized official
• Steven L Nelson, PA-C

  • Surgical Physician Assistant
  • Pocatello, ID
  • NPI 1659689362
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1298937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572825600000",
    "number": "1033417035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 HOSPITAL WAY",
            "address_2": "STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012789",
            "telephone_number": "208-478-4522",
            "fax_number": "208-478-2935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 HOSPITAL WAY",
            "address_2": "STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012789",
            "telephone_number": "208-478-4522",
            "fax_number": "208-478-2935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO SPORTS & SPINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-01",
        "last_updated": "2019-11-04",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-478-4522",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "ID",
            "license": "O-0400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christopher R Johnson DO, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Idaho Orthopedic & Sports Clinic PA
• Idaho Pathology Laboratory Physicians
• Idaho Prosthetics & Orthotics, Inc.
• Idaho Regional Hand & Upper Extremity Center PLLC
• Idaho Sport Massage LLC
• Idaho State University
• Idaho State University
• Idaho State University
• Idaho State University
• Idaho State University

• Sports Medicine (Family Medicine) Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Sports Medicine (Family Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.