Individual provider Active NPI

Randall Fowler, MD

  • Emergency Medicine Physician
  • Pocatello, ID
National Provider Identifier
1154344059
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
M5953 Issued in ID
Practice address
651 Memorial Dr
Pocatello, ID 83201-4071
Phone
(208) 239-1000
NPI assigned
Jul 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X M5953 ID Primary

Addresses

Primary practice location

651 Memorial Dr
Pocatello, ID 83201-4071

Mailing address

651 Memorial Dr
Pocatello, ID 83201-4071
Phone (208) 239-1000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20090416000495 ID Practitioner - Emergency MedicinePractitioner - Family Practice 8224185244 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M5953IDMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Health Services, LLC Current Accepting new patients
Pocatello Health Services, LLC CurrentSince Mar 21, 2014 Accepting new patients
Teton Valley Health Care Inc Emergency Medicine CurrentSince Jan 1, 2012 Accepting new patients
Teton Valley Health Care Inc Current Accepting new patients
Teton Valley Health Care, Inc CurrentSince Jan 1, 2012 Accepting new patients
Pocatello Health Services, LLC CurrentSince Mar 21, 2014 Accepting new patients
Medical Imaging Associates of Idaho Falls, Inc Past Accepting new patients
Teton Valley Health Care Inc Past Accepting new patients

Locations

120 E Howard St
Driggs, ID 83422
Phone (208) 354-2302

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

Interoperability endpoints

  • Direct secure messaging: rfowler179525@ahs.direct-ci.com

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154344059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "RANDALL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M5953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.