NPIMap

Individual provider Active NPI

Jeffrey D Hancock, MD

  • Pediatrics Physician
  • Rexburg, ID
National Provider Identifier
1265637573
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5755112-1205 Issued in UT
Practice address
380 Walker Dr
Rexburg, ID 83440-1657
Phone
(208) 356-9559
NPI assigned
Jun 18, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5755112-1205 UT Primary

Addresses

Primary practice location

380 Walker Dr
Rexburg, ID 83440-1657

Mailing address

1707 W 2175 S
Syracuse, UT 84075-8565
Phone (801) 725-0280

Other identifiers 3

IdentifierTypeStateIssuer
000010163793OtherIDBLUE SHIELD
8J950OtherIDBLUE CROSS
807823000MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070827000608 ID Practitioner - Hematology/OncologyPractitioner - Pediatric Medicine 3577465319 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Pediatric Medicine
Education
University of Utah School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

Hospital & facility affiliations

  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Teton Valley Hospital Hospital, Driggs, ID, CCN 131313
  • Star Valley Medical Center Hospital, Afton, WY, CCN 531313
  • Idaho Falls Community Hospital, LLC Hospital, Idaho Falls, ID, CCN 130074
  • Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
5755112-1205UTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Hospital LLC CurrentSince Nov 15, 2010 Accepting new patients
Mountain View Hospital LLC CurrentSince Nov 15, 2010 Accepting new patients
Mountain View Hospital Physician Organization Past Accepting new patients
Ihc Health Services, Inc. Past Accepting new patients

Locations

1957 E 17th St
Idaho Falls, ID 83404
Phone (208) 523-1100

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

2327 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-1000

380 Walker Dr
Rexburg, ID 83440
Phone (208) 356-9559

Interoperability endpoints

  • Direct secure messaging: jhancock@tetoncancer.direct.varian.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1265637573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 W 2175 S",
            "city": "SYRACUSE",
            "state": "UT",
            "postal_code": "840758565",
            "telephone_number": "801-725-0280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 WALKER DR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401657",
            "telephone_number": "208-356-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANCOCK",
        "first_name": "JEFFREY",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-18",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "5755112-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010163793",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8J950",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807823000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.