Active NPI
Nikolaus Konrad Neudorf, MD
- Internal Medicine Physician
- Twin Falls, ID
National Provider Identifier
1174142244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- M-17802
- Practice address
- 801 Pole Line Rd W
Twin Falls, ID 83301-5810 - Phone
- (208) 814-4100
- Fax
- (208) 814-4908
- NPI assigned
- Apr 9, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | M-17802 | ID | Primary |
Addresses
Primary practice location
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Mailing address
190 E Bannock St
Boise, ID 83712-6241
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of New Mexico School of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone (208) 814-1000
Hospital & facility affiliations
- St Lukes Magic Valley Medical Center
- St Luke'S Wood River Medical Center
- St Luke'S Regional Medical Center
- St Luke'S Jerome
- St Luke'S Elmore Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.09 of 100
- Quality
- 77.1
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.19
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Luke'S Clinic LLC | Internal Medicine | Current | Accepting new patients |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
801 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000
746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230
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.
-
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Jerome, ID
- NPI 1366874877
-
- Critical Access Hospital
- Mountain Home, ID
- NPI 1699013565
-
- General Acute Care Hospital
- Boise, ID
- NPI 1770586794
-
- Critical Access Hospital
- Ketchum, ID
- NPI 1508869470
-
- General Acute Care Hospital
- Twin Falls, ID
- NPI 1932154705
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722988800000",
"number": "1174142244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 POLE LINE RD W",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015810",
"telephone_number": "208-814-4100",
"fax_number": "208-814-4908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NEUDORF",
"first_name": "NIKOLAUS",
"middle_name": "KONRAD",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-09",
"last_updated": "2024-08-07",
"certification_date": "2024-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "ID",
"license": "M-17802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.