NPIMap

Individual provider Active NPI

Gregory R. Hodson, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Idaho Falls, ID
National Provider Identifier
1164426771
Registry record updated Jul 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
01076326A Issued in IN
Practice address
2225 Teton PLZ
Ste B
Idaho Falls, ID 83404-6494
Phone
(208) 524-4660
Fax
(208) 524-4617
NPI assigned
Jun 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X M6479 ID
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 01076326A IN Primary

Addresses

Primary practice location

2225 Teton PLZ
Ste B
Idaho Falls, ID 83404-6494

Mailing address

2225 Teton PLZ
Ste B
Idaho Falls, ID 83404-6494
Phone (208) 524-4660

Other identifiers 2

IdentifierTypeStateIssuer
000001021963OtherINANTHEM PROVIDER NUMBER UNDER TIN 35-2030653
201352320MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M6479IDMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain States Cardiovascular and PastSince Nov 2, 2006 Accepting new patients
East Falls Cardiovascular and Thoracic Surgery, LLC Thoracic Surgery (Cardiothoracic Vascular Surgery) Past Accepting new patients

Organizations & group practices 2

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": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1164426771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 TETON PLZ",
            "address_2": "STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046494",
            "telephone_number": "208-524-4660",
            "fax_number": "208-524-4617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 TETON PLZ",
            "address_2": "STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046494",
            "telephone_number": "208-524-4660",
            "fax_number": "208-524-4617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODSON",
        "first_name": "GREGORY",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-10",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "ID",
            "license": "M6479",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IN",
            "license": "01076326A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER UNDER TIN 35-2030653",
            "identifier": "000001021963",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201352320",
            "state": "IN"
        }
    ],
    "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 26, 2016; 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.