Individual provider Active NPI

Austin C Gillette

  • Family Medicine Physician
  • Rexburg, ID
National Provider Identifier
1083810287
Registry record updated Nov 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-10581 Issued in ID
Practice address
21 Winn Dr
Rexburg, ID 83440-5277
Phone
(208) 881-5222
Fax
(877) 441-4715
NPI assigned
Jun 25, 2007
Last updated
Nov 19, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2019

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 M-10581 ID Primary

Addresses

Primary practice location

21 Winn Dr
Rexburg, ID 83440-5277

Mailing address

21 Winn Dr
Rexburg, ID 83440-5277
Phone (208) 881-5222

Other identifiers 1

IdentifierTypeStateIssuer
11243745OtherAAMC ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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 1

Enrollment IDStateProvider typePAC IDDetails
I20100922000825 ID Practitioner - Family Practice 6800912288 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Ohio State University College of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fall River Medical PLLCGroup PAC ID 4981846698, 8 clinicians

Practice addresses (Care Compare)

2000 Trappers Loop
Rexburg, ID 83440-4104
Phone (208) 881-5222

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-10581IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fall River Medical, PLLC CurrentSince Jul 1, 2013 Accepting new patients
Madison Co Memorial Hospital Family Medicine PastSince Nov 24, 2019 Accepting new patients

Locations

2000 Trappers Loop
Rexburg, ID 83440
Phone (208) 881-5222

21 Winn Dr
Rexburg, ID 83440
Phone (208) 881-5222

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 2

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 2

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": "1182729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574121600000",
    "number": "1083810287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 WINN DR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405277",
            "telephone_number": "208-881-5222",
            "fax_number": "877-441-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 WINN DR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405277",
            "telephone_number": "208-881-5222",
            "fax_number": "877-441-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLETTE",
        "first_name": "AUSTIN",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-25",
        "last_updated": "2019-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-10581",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AAMC ID",
            "identifier": "11243745",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.