NPIMap

Organization Active NPI

Greenwald Neurosurgical

  • Specialist
  • Idaho Falls, ID
National Provider Identifier
1124198403
Registry record updated Jul 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
M-6947 Issued in ID
Legal business name
GREENWALD NEUROSURGICAL
Practice address
3155 Channing Way
Suite B
Idaho Falls, ID 83404-7546
Phone
(208) 535-4800
Fax
(208) 535-4807
NPI assigned
Nov 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2009

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

Authorized official

Name
Ms. Janeene A Ditmore
Title
Office Manager
Phone
(208) 535-4800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X M-6947 ID Primary

Addresses

Primary practice location

3155 Channing Way
Suite B
Idaho Falls, ID 83404-7546

Mailing address

3155 Channing Way
Suite B
Idaho Falls, ID 83404-7546
Phone (208) 535-4800

Other identifiers 3

IdentifierTypeStateIssuer
76836OtherIDBLUE CROSS
8M987OtherIDBLUE CROSS PRACTICE
000010001551OtherIDBLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1124198403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3155 CHANNING WAY",
            "address_2": "SUITE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047546",
            "telephone_number": "208-535-4800",
            "fax_number": "208-535-4807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3155 CHANNING WAY",
            "address_2": "SUITE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047546",
            "telephone_number": "208-535-4800",
            "fax_number": "208-535-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENWALD NEUROSURGICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "DITMORE",
        "authorized_official_first_name": "JANEENE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-535-4800",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "M-6947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "76836",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PRACTICE",
            "identifier": "8M987",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010001551",
            "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 Jul 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.