Philip Jon Van de Griend, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M-15982 Issued in ID

Practice address

465 Memorial Dr
Pocatello, ID 83201-4008

Phone

(208) 232-7862

NPI assigned

Jun 27, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 2

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family PracticeAlso: Sports Medicine

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Health West IncGroup PAC ID 4981500931, 67 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: philip.van.de.griend.1@16258.direct.athenahealth.com

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.

• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Preston, ID
  • NPI 1033595541
  Medicare reassignment Care Compare group NPD
• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1689802852
  Medicare reassignment NPD
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Aberdeen, ID
  • NPI 1295734796

  Family Medicine

  NPD
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Downey, ID
  • NPI 1588666945

  Family Medicine

  NPD
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • American Falls, ID
  • NPI 1629077235

  Family Medicine

  NPD
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pocatello, ID
  • NPI 1740143882
  NPD
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pocatello, ID
  • NPI 1942772223

  Family Medicine

  NPD
• Pocatello Health Services, LLC

  • Durable Medical Equipment & Medical Supplies
  • Pocatello, ID
  • NPI 1154089126
  NPD
• Pocatello Health Services, LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1215165485
  NPD
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pocatello, ID
  • NPI 1013547801
  NPD (past)
• Health West, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chubbuck, ID
  • NPI 1629499751
  NPD (past)
• Idaho State University Health Center

  • Student Health Clinic/Center
  • Pocatello, ID
  • NPI 1336214618
  NPD (past)

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

• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632960000000",
    "number": "1275829376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-234-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-232-7862"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Lincoln Cir SE",
            "address_purpose": "LOCATION",
            "city": "Orange City",
            "state": "IA",
            "postal_code": "510411836",
            "country_code": "US",
            "telephone_number": "712-737-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN DE GRIEND",
        "first_name": "PHILIP",
        "middle_name": "JON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-27",
        "last_updated": "2021-09-30",
        "certification_date": "2021-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "MD-42445",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL33736",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2014-01351",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-15982",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NC2135",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275829376",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valley View Anesthesia PA
• Valley View Health Services, Inc.
• Valley View Health Services, Inc.
• Janellie Valmaceda
• Value Directed Counseling, LLC
• Rufus Van Dyke III, DDS, MCL.D
• Jaynie Van Quill
• Barton Vandenburg, LPC, NCC
• Naomi Vanderlinden
• Bailey Elizabeth Vanderwall

• Family Medicine Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2021; 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.

Verify at the official NPI Registry.