NPIMap

Organization Active NPI

Intermountain Emergency Physicians

  • Emergency Medicine Physician
  • Idaho Falls, ID
National Provider Identifier
1124005467
Registry record updated Oct 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
INTERMOUNTAIN EMERGENCY PHYSICIANS
Practice address
3100 Channing Way
Idaho Falls, ID 83404-7533
Phone
(208) 535-4130
Fax
(208) 535-4125
NPI assigned
Dec 28, 2005
Last updated
Oct 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2021

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

Authorized official

Name
Matthew R. Griggs, MDNPI 1235355702
Title
Managing Partner
Phone
(208) 535-4103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

3100 Channing Way
Idaho Falls, ID 83404-7533

Mailing address

PO Box 1647
2860 Channing Way Suite 115
Idaho Falls, ID 83403-1647
Phone (208) 535-4130

Other identifiers 2

IdentifierTypeStateIssuer
806633300MedicaidID
8H997OtherIDBLUE CROSS GROUP #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031229000484 ID Part B Supplier - Clinic/Group Practice 5991603920 Receives reassigned benefits from 27 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633392000000",
    "number": "1124005467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1647",
            "address_2": "2860 CHANNING WAY SUITE 115",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834031647",
            "telephone_number": "208-535-4130",
            "fax_number": "208-535-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "208-535-4130",
            "fax_number": "208-535-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN EMERGENCY PHYSICIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-28",
        "last_updated": "2021-10-05",
        "certification_date": "2021-10-05",
        "status": "A",
        "authorized_official_last_name": "GRIGGS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "208-535-4103",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806633300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP #",
            "identifier": "8H997",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.