Nicholas Anderson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1788 Issued in ID

Practice address

3200 Channing Way Ste 206
Idaho Falls, ID 83404-7546

Phone

(208) 529-2230

Fax

(208) 453-6142

NPI assigned

Oct 17, 2018

Last updated

Jun 9, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Steele Lake Specialty PLLCGroup PAC ID 1153774567, 20 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Steele Lake Specialty PLLC

  • Surgery Physician
  • Idaho Falls, ID
  • NPI 1215716998
  Medicare reassignment Care Compare group
• Ridgeline Medical LLC

  • Family Medicine Physician
  • Idaho Falls, ID
  • NPI 1386110963
  Medicare reassignment
• Saint Alphonsus Regional Medical Center Inc

  • Psychologist
  • Boise, ID
  • NPI 1649357716
  Medicare reassignment
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1992736649
  NPD
• Saint Alphonsus Specialty Services Inc

  • Trauma Surgery Physician
  • Boise, ID
  • NPI 1093040479
  NPD (past)
• Columbia River Health

  • Federally Qualified Health Center (FQHC)
  • Boardman, OR
  • NPI 1710084140
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastern Idaho Health Services Inc

  dba Eastern Idaho Regional Medical Center

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation

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

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1093281016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE A206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047586",
            "telephone_number": "208-529-2230",
            "fax_number": "208-561-8061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 CHANNING WAY STE 206",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047546",
            "telephone_number": "208-529-2230",
            "fax_number": "208-453-6142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "NICHOLAS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-17",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayda Rae Anderson
• Kelly Jarom Anderson, MD
• Melissa R Anderson, MASTERS OT
• Michael S Anderson, PT
• Michelle Anderson
• Russell Anderson, LSW
• Taylor K Anderson, D.O.
• Whitney C Anderson, LMSW
• Andre's House (Avot)
• Andrew L McCall DPM PA (Ankle and Foot Clinic of Idaho)

• Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.