Katrina E Spangenberg, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MRM-2045 Issued in ID

Practice address

465 Memorial Dr
Pocatello, ID 83201-4008

Phone

(208) 234-4700

NPI assigned

May 21, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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 Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Midtown Community Health Center Inc 26 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles (3 of 4)

Locations

Networks

• UT PPO

Interoperability endpoints

• Direct secure messaging: kspangenberg357000@ahs.direct-ci.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.

• Midtown Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Ogden, UT
  • NPI 1548267420

  UT

  Medicare reassignment Care Compare group NPD
• Midtown Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Washington Terrace, UT
  • NPI 1013186717
  Care Compare group NPD (past)
• Midtown Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • South Salt Lake, UT
  • NPI 1033547567
  Care Compare group
• Midtown Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Ogden, UT
  • NPI 1447495981
  Care Compare group
• Midtown Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Clearfield, UT
  • NPI 1467644740
  Care Compare group
• Midtown Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Ogden, UT
  • NPI 1609254796
  Care Compare group
• Midtown Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Logan, UT
  • NPI 1053780171
  NPD

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

{
    "created_epoch": "1621555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1285209296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 ADAMS AVE",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011511",
            "telephone_number": "801-393-5355"
        },
        {
            "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": "208-234-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPANGENBERG",
        "first_name": "KATRINA",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-05-21",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "13821094-1205",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRM-2045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Idaho Gastroenterology,PLLC
• Southeast Idaho Orthodontics, PLLC
• Southeastern District Health Department
• Southeastern District Health Department
• Southeastern District Health Dept.
• Michael Sparks
• Trevor Sparrow
• Brianna Spaulding, LMSW
• Kelli Spaulding, LMSW
• Specialized Family Medicine

• 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 Oct 29, 2024; 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.