Tanner D Mitton, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1262 Issued in ID

Practice address

1355 Parkway Dr Ste a
Blackfoot, ID 83221-1656

Phone

(986) 275-0003

Fax

(986) 275-0005

NPI assigned

Jun 18, 2015

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

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, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wray DermatologyGroup PAC ID 8921541277, 3 clinicians

Gregory M Ford MD PLLCGroup PAC ID 8921225483, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tmitton262028@ahs.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wray Dermatology

  • Dermatology Physician
  • Blackfoot, ID
  • NPI 1457110298
  Medicare reassignment Care Compare group NPD (past)
• Gregory M. Ford, MD PLLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Pocatello, ID
  • NPI 1477965952
  Medicare reassignment Care Compare group
• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1689802852
  Medicare reassignment NPD
• Pocatello Health Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pocatello, ID
  • NPI 1154089126
  NPD
• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1215165485
  NPD
• Pocatello Hospital LLC

  • Internal Medicine Physician
  • Pocatello, ID
  • NPI 1760610935
  NPD (past)

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

• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782777600000",
    "number": "1144601865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 PARKWAY DR STE A",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211656",
            "telephone_number": "986-275-0003",
            "fax_number": "986-275-0005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 PARKWAY DR STE A",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211656",
            "telephone_number": "986-275-0003",
            "fax_number": "986-275-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTON",
        "first_name": "TANNER",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-18",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kirt M McKinlay, MD
• Jody Jon McLaws
• MH Health Care Services, PC
• Camile Michaelson, RD, LD
• Robert Nathan Miller, PHARM-D
• Jordan Breanne Moore
• Alex Morgan, CRNA
• Zachary D Morrow
• Amy Moser, M.S. CCC-SLP
• Francis Bryce Moser, DO

• Physician Assistant in Blackfoot, ID
• Providers in Blackfoot, 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 30, 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.