Idaho Modern Medicine - PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

IDAHO MODERN MEDICINE - PLLC

Practice address

1000 Pocatello Creek Rd Ste E10
Pocatello, ID 83201-2953

Phone

(208) 317-5371

NPI assigned

Jan 31, 2020

Organization subpart

No

Name

Michael A Anderson, DONPI 1124406186

Title

Physician / Owner

Phone

(208) 648-4789

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael A Anderson, DO

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1124406186

  Family Medicine, ID

  Medicare reassignment NPD Authorized official

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

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in ID

Locations

Interoperability endpoints

• Direct secure messaging: idahomodernmedicinemichaelanderson@144946.advancedmd-direct.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 5, 2024.

{
    "created_epoch": "1580428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707091200000",
    "number": "1184255754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 POCATELLO CREEK RD STE E10",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012953",
            "telephone_number": "208-648-4789",
            "fax_number": "208-648-4790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 POCATELLO CREEK RD STE E10",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012953",
            "telephone_number": "208-317-5371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO MODERN MEDICINE - PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-31",
        "last_updated": "2024-02-05",
        "certification_date": "2024-02-05",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN / OWNER",
        "authorized_official_telephone_number": "208-648-4789",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "IdahoModernmedicineMichaelAnderson@144946.advancedmd-direct.com",
            "affiliation": "N",
            "address_1": "1000 Pocatello Creek Rd Ste E10",
            "city": "Pocatello",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832012953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Idaho Prosthetics & Orthotics, Inc.
• Idaho Regional Hand & Upper Extremity Center PLLC

• All providers in Pocatello, ID
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2024; 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.