Rylan Anderson, DO
Individual provider Active NPI Family Medicine Physician · Pocatello, ID
NPI 1184317554 · NPPES record last updated Jan 21, 2025
Key facts
- NPI
- 1184317554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 8161170 (ID)
- Practice address
- 465 Memorial Dr
Pocatello, ID 83201-4008 - Phone
- (208) 232-7862
- NPI assigned
- May 31, 2023
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
150 N 200
Malad City, ID 83252-1239
65 E 100
Gunnison, UT 84634-7709
PO Box
Suite 167
Kaysville, UT 84037
PO Box
Suite 4168
Pocatello, ID 83205
PO Box
Suite 4168
Pocatello, ID 83205-4168
Hospital & facility affiliations
- Nell J Redfield Memorial Hospital
- Portneuf Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260128004410 | ID | Practitioner - Family Practice | 9436519808 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8161170 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oneida County Hospital | Current |
Accepting new patients | |
| Oneida County Hospital | Current |
Accepting new patients |
Interoperability endpoints
- randerson877648@ahs.direct-ci.com
- rylan.anderson.1@16258.direct.athenahealth.com
- rylan.anderson.1@13153.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 8161170 | ID | Yes |
Addresses
Primary practice location
465 Memorial Dr
Pocatello, ID 83201-4008
Mailing address
500 S 11TH Ave Ste 400
Pocatello, ID 83201-4880
Phone (208) 232-7862
Other providers in Pocatello, ID
- Katherine Ann Anderson
- Matthew Anderson
- Michael A Anderson
- Morgan Newel Anderson
- Natalie Anderson
- Shantay Anderson
- David Anderton
- Josie Andreski
- Andrew Stoddard Dental Services, PLLC
- Kimberly Jo Andrew
All providers in Pocatello, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.