Kelly L Dustin, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

O-0459 Issued in ID

Practice address

21 Winn Dr
Rexburg, ID 83440-5277

Phone

(208) 881-5222

Fax

(877) 441-4715

NPI assigned

Jul 4, 2006

Last updated

Nov 19, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Family Practice

Education

At Still University of Health Sciences, College of Osteo Med, Kirksville, 2006

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)

Hospital & facility affiliations

• Madison Memorial Hospital Hospital, Rexburg, ID, CCN 130025

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Fall River Medical, PLLC

  • Primary Care Clinic/Center
  • Rexburg, ID
  • NPI 1457698987
  Medicare reassignment Care Compare group
• Madison Co Memorial Hospital

  dba Rigby Medical Center

  • Family Medicine Physician
  • Rigby, ID
  • NPI 1356026280
  NPD (past)

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

• Madison Co Memorial Hospital

  dba Seasons Medical By Madison Memorial

  • Obstetrics & Gynecology Physician
  • Rexburg, ID
  • NPI 1073154266

  Hospital

  Care Compare affiliation
• Madison Co Memorial Hospital

  • General Acute Care Hospital
  • Rexburg, ID
  • NPI 1992747570
  Care Compare affiliation

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574121600000",
    "number": "1114957362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 EASTLAND DR",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016856",
            "telephone_number": "208-734-3312",
            "fax_number": "208-734-5036"
        },
        {
            "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": "DUSTIN",
        "first_name": "KELLY",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2019-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0459",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ID",
            "license": "MR0875",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8035175",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kerry Anne Draney, LCSW
• Jacob Dresen, LPC
• Kylee Duce
• Elizabeth Marlowe Dummar
• Matthew Dunham
• Dwayne M. Hansen MD PLLC
• Paul M Dye, MPT, MOTR/L, ATC,
• Eagle Rock Dental Care of Rexburg
• Eagle Vision Center PC
• East Idaho Mental Health LLC

• Family Medicine Physician in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; 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.