Individual provider Active NPI

Patrick Connor Spotts, MD

  • Emergency Medicine Physician
  • Idaho Falls, ID
National Provider Identifier
1053832212
Registry record updated Jan 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
41056 Issued in SC
Practice address
2325 Coronado St
Idaho Falls, ID 83404-7407
Phone
(864) 416-1090
NPI assigned
Jun 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 41056 SC Primary
Emergency Medicine Physician 207P00000X M-14679 ID

Addresses

Primary practice location

2325 Coronado St
Idaho Falls, ID 83404-7407

Mailing address

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (864) 416-1090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190522003366 SC Practitioner - Emergency Medicine 2062778228 Reassigns benefits to 1 organization
I20220117000593 ID Practitioner - Emergency Medicine 2062778228 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-14679IDMDEmergency Medicine Physician
41056SCMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Hospital LLC CurrentSince Oct 13, 2024 Accepting new patients
McLeod Health Cheraw CurrentSince Jul 1, 2019 Accepting new patients
Steele Memorial Medical Center CurrentSince Dec 1, 2021 Accepting new patients
Steele Memorial Medical Center CurrentSince Dec 1, 2021 Accepting new patients
McLeod Health Cheraw Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients

Locations

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

203 S Daisy St
Salmon, ID 83467
Phone (208) 756-4291

711 Chesterfield Hwy
Cheraw, SC 29520
Phone (843) 320-3304

Interoperability endpoints

  • Direct secure messaging: pspotts2204158@wm.providencedirect.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1498608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769817600000",
    "number": "1053832212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2325 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "864-416-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2325 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "864-416-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPOTTS",
        "first_name": "PATRICK",
        "middle_name": "CONNOR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-28",
        "last_updated": "2026-01-31",
        "certification_date": "2026-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "41056",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-14679",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.