Tony C Roisum MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M7389 Issued in ID

Legal business name

TONY C ROISUM MD PA

Practice address

3360 Washington Pkwy
Suite 1
Idaho Falls, ID 83404-8333

Phone

(208) 524-3416

Fax

(208) 524-3138

NPI assigned

Oct 5, 2006

Reactivated

Dec 9, 2008

Organization subpart

No

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

Authorized official

Name

Jacqueline Kelsey

Title

Office Manager

Phone

(208) 524-3416

Specialties & licenses 2

Addresses

Other identifiers 8

Other names 1

• Idaho Falls Family & Sports Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/13787/brand/1/csg/1/fhir/r4

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyson Craig Parker, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1295921484
  Medicare reassignment Care Compare group NPD
• Laurren Ashley Bennett, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1104419431
  Medicare reassignment Care Compare group
• Tanner Blaylock Bodily

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1356957039
  Medicare reassignment Care Compare group
• Laura Ivie, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1205135456
  Medicare reassignment Care Compare group
• Matthew J Merzlock, PA-C

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1316985229
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768521600000",
    "number": "1124115944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3360 WASHINGTON PKWY STE 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047592",
            "telephone_number": "208-524-3416",
            "fax_number": "208-524-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 WASHINGTON PKWY",
            "address_2": "SUITE 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048333",
            "telephone_number": "208-524-3416",
            "fax_number": "208-524-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TONY C ROISUM MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "deactivation_date": "2007-07-24",
        "reactivation_date": "2008-12-09",
        "status": "A",
        "authorized_official_last_name": "KELSEY",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-524-3416"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M7389",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": "ID",
            "license": "M7389",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010004286",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "B5824",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "DJ475",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119166700",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "185461600",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502862456001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "23397",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805076700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Falls Family & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bruce G Tolman, DPM
• Keily Maya Tomchak, PA-C
• Luana Tomchak, R.D.
• Mary Louise Tompkins
• Amy Tonks
• Nedra Toponce, LMFT
• Lance Torngren, PHARMD
• Total Care Chiropractic
• Total Family Medicine PLLC
• Total Renal Care Inc

• Family Medicine Physician in Idaho Falls, ID
• Providers in Idaho Falls, 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 Jan 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.