NPIMap

Organization Active NPI

Rodney H Hillam DDS Ms PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Idaho Falls, ID
National Provider Identifier
1306973862
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
2019 Issued in ID
Legal business name
RODNEY H HILLAM DDS MS PA
Practice address
3325 S Holmes Ave
Idaho Falls, ID 83404-7981
Phone
(206) 524-1800
Fax
(208) 524-1890
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Rodney H Hillam, DDS MS PANPI 1225289390
Title
Owner President
Phone
(208) 524-1800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 2019 ID Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X 918 WY

Addresses

Primary practice location

3325 S Holmes Ave
Idaho Falls, ID 83404-7981

Mailing address

3325 S Holmes Ave
Idaho Falls, ID 83404-7981
Phone (206) 524-1800

Other identifiers 2

IdentifierTypeStateIssuer
840380OtherUNITED CONCORDIA
60301OtherBLUECROSS

National Provider Directory

National Provider Directory

Locations

3325 S Holmes Ave
Idaho Falls, ID 83404
Phone (206) 524-1800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306973862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3325 S HOLMES AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047981",
            "telephone_number": "206-524-1800",
            "fax_number": "208-524-1890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3325 S HOLMES AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047981",
            "telephone_number": "206-524-1800",
            "fax_number": "208-524-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODNEY H HILLAM DDS MS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HILLAM",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "208-524-1800",
        "authorized_official_credential": "DDS MS PA"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "2019",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WY",
            "license": "918",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "840380",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS",
            "identifier": "60301",
            "state": null
        }
    ],
    "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 Aug 22, 2020; 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.