Active NPI
Timothy McHugh
- Physician Assistant
- Idaho Falls, ID
National Provider Identifier
1194264127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA-1479
- Practice address
- 150 Shoup Ave
Suite 17
Idaho Falls, ID 83402-3657 - Phone
- (208) 528-5755
- NPI assigned
- Feb 23, 2017
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-1479 | ID | Primary |
Addresses
Primary practice location
150 Shoup Ave
Suite 17
Idaho Falls, ID 83402-3657
Mailing address
150 Shoup Ave
Suite 17
Idaho Falls, ID 83402-3657
Phone (208) 528-5755
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-1479 | ID | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487808000000",
"number": "1194264127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 SHOUP AVE",
"address_2": "SUITE 17",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834023657",
"telephone_number": "208-528-5755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 SHOUP AVE",
"address_2": "SUITE 17",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834023657",
"telephone_number": "208-528-5755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCHUGH",
"first_name": "TIMOTHY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-23",
"last_updated": "2017-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA-1479",
"primary": true
}
],
"identifiers": [],
"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 Feb 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.