NPIMap

Organization Active NPI

East Idaho Orthopaedics PLLC

Doing business as Liljenquist & Redd Orthopedic Surgery

  • Orthopaedic Surgery Physician
  • Idaho Falls, ID
National Provider Identifier
1295189918
Registry record updated Apr 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
M-9781 Issued in ID
Legal business name
EAST IDAHO ORTHOPAEDICS PLLC
Doing business as
Liljenquist & Redd Orthopedic Surgery
Practice address
3405 Merlin Dr
Idaho Falls, ID 83404-7430
Phone
(208) 522-3355
Fax
(208) 522-6019
NPI assigned
Apr 19, 2016
Last updated
Apr 19, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2016

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

Authorized official

Name
Mrs. Alexis L Bergeson
Title
Practice Manager
Phone
(208) 932-4133

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X M-10197 ID
Orthopaedic Surgery Physician 207X00000X M-9781 ID Primary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X M-9781 ID

Addresses

Primary practice location

3405 Merlin Dr
Idaho Falls, ID 83404-7430

Mailing address

3405 Merlin Dr
Idaho Falls, ID 83404-7430
Phone (208) 522-3355

Other names 1

  • Liljenquist & Redd Orthopedic Surgery Doing business as

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14639/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1461024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461024000000",
    "number": "1295189918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3405 MERLIN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047430",
            "telephone_number": "208-522-3355",
            "fax_number": "208-522-6019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 MERLIN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047430",
            "telephone_number": "208-522-3355",
            "fax_number": "208-522-6019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST IDAHO ORTHOPAEDICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-19",
        "last_updated": "2016-04-19",
        "status": "A",
        "authorized_official_last_name": "BERGESON",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "208-932-4133",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": "M-10197",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": "M-9781",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "ID",
            "license": "M-9781",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liljenquist & Redd Orthopedic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.