NPIMap

Organization Active NPI

Santibanez Pac Idaho

  • Geriatric Medicine (Internal Medicine) Physician
  • Idaho Falls, ID
National Provider Identifier
1346015948
Registry record updated Aug 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
SANTIBANEZ PAC IDAHO
Practice address
840 E Elva St
Idaho Falls, ID 83401-2801
Phone
(208) 523-4795
NPI assigned
Nov 24, 2023
Last updated
Aug 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2026

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

Authorized official

Name
Julie Roser
Title
VP of Operations
Phone
(775) 222-0045

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU Primary

Addresses

Primary practice location

840 E Elva St
Idaho Falls, ID 83401-2801

Mailing address

400 E Rivulon Blvd Ste 103
Gilbert, AZ 85297-0096
Phone (888) 408-7008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240215000080 ID Part B Supplier - Clinic/Group Practice 2961846209 Receives reassigned benefits from 25 practitioners
Practice locations: Idaho Falls, ID
O20260325002253 MI Part B Supplier - Clinic/Group Practice 2961846209 Receives reassigned benefits from 1 practitioner
Practice locations: Grandville, MI; Greenville, MI; Howell, MI; Lamont, MI; Lansing, MI; Marshall, MI; Montrose, MI; Okemos, MI…

National Provider Directory

National Provider Directory

Locations

1950 1st St
Idaho Falls, ID 83401
Phone (208) 715-5500

3620 Potomac Way
Idaho Falls, ID 83404
Phone (208) 238-0088

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1700784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786320000000",
    "number": "1346015948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E RIVULON BLVD STE 103",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852970096",
            "telephone_number": "888-408-7008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 E ELVA ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834012801",
            "telephone_number": "208-523-4795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTIBANEZ PAC IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-24",
        "last_updated": "2026-08-10",
        "certification_date": "2026-08-10",
        "status": "A",
        "authorized_official_last_name": "ROSER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "775-222-0045"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.