NPIMap

Individual provider Active NPI

Marc Allan, DO

  • Family Medicine Physician
  • Twin Falls, ID
National Provider Identifier
1073043337
Registry record updated Jan 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-1180 Issued in ID
Practice address
512 Pole Line Rd Ste 2
Twin Falls, ID 83301-6367
Phone
(208) 735-3636
Fax
(208) 735-3637
NPI assigned
Jun 19, 2017
Last updated
Jan 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-1180 ID Primary

Addresses

Primary practice location

512 Pole Line Rd Ste 2
Twin Falls, ID 83301-6367

Mailing address

512 Pole Line Rd Ste 2
Twin Falls, ID 83301-6367
Phone (208) 735-3636

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
I20200626001845 ID Practitioner - Family Practice 6103195920 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovative Family Medicine of Idaho PLLCGroup PAC ID 2668820556, 9 clinicians

Practice addresses (Care Compare)

1411 Fall Ave
Suite 1301
Twin Falls, ID 83301-3467
Phone (208) 254-0047

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O-1180IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Family Medicine of Idaho PLLC Family Medicine CurrentSince Jan 1, 2024 Accepting new patients

Locations

1411 Falls Ave E
Ste 1301
Twin Falls, ID 83301
Phone (208) 732-0067

1411 Fillmore St
Ste 600
Twin Falls, ID 83301
Phone (208) 933-4400

512 Pole Line Rd
Twin Falls, ID 83301
Phone (208) 302-3311

512 Pole Line Rd
#2
Twin Falls, ID 83301
Phone (208) 254-0047

526 Shoup Ave W
Twin Falls, ID 83301
Phone (208) 733-2400

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IEJBDD
  • Direct secure messaging: mallando85628@direct.slhs.org

Organizations & group practices 1

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 11

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": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1073043337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 POLE LINE RD STE 2",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016367",
            "telephone_number": "208-735-3636",
            "fax_number": "208-735-3637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 POLE LINE RD STE 2",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016367",
            "telephone_number": "208-735-3636",
            "fax_number": "208-735-3637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLAN",
        "first_name": "MARC",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-19",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-1180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.