Organization Active NPI

Obstetrics and Gynecology Associates of Idaho Falls

  • Obstetrics & Gynecology Physician
  • Idaho Falls, ID
National Provider Identifier
1164531943
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OBSTETRICS AND GYNECOLOGY ASSOCIATES OF IDAHO FALLS
Practice address
2065 E 17TH St
Suite D
Idaho Falls, ID 83404-8042
Phone
(208) 522-0747
Fax
(855) 830-4276
NPI assigned
Aug 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Authorized official

Name
Tess Hibbert
Title
Assistant Office Manager
Phone
(208) 522-0747

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

2065 E 17TH St
Suite D
Idaho Falls, ID 83404-8042

Mailing address

2065 E 17TH St
Suite D
Idaho Falls, ID 83404-8042
Phone (208) 522-0747

Other names 1

  • OB-GYN Assoc of Idaho Falls Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060405000324 ID Part B Supplier - Clinic/Group Practice 2466460225 Receives reassigned benefits from 2 practitioners
Practice locations: Idaho Falls, ID

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D0520943Obstetrics and Gynecology Associates2065 E 17TH St Suite D, Idaho Falls, ID 83404ComplianceAug 29, 2026

National Provider Directory

National Provider Directory

Locations

2065 E 17th St
Ste D
Idaho Falls, ID 83404
Phone (208) 522-0747

Practitioners & affiliated clinicians

Practitioners 9

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": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675296000000",
    "number": "1164531943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2065 E 17TH ST",
            "address_2": "SUITE D",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048042",
            "telephone_number": "208-522-0747",
            "fax_number": "208-522-9641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2065 E 17TH ST",
            "address_2": "SUITE D",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048042",
            "telephone_number": "208-522-0747",
            "fax_number": "855-830-4276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBSTETRICS AND GYNECOLOGY ASSOCIATES OF IDAHO FALLS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A",
        "authorized_official_last_name": "HIBBERT",
        "authorized_official_first_name": "TESS",
        "authorized_official_title_or_position": "ASSISTANT OFFICE MANAGER",
        "authorized_official_telephone_number": "208-522-0747"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OB-GYN Assoc of Idaho Falls",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OB-GYN Assoc of Idaho Falls",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 2, 2023; 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.