NPIMap

Individual provider Active NPI

Susan Lynn Bunnell, MD

  • Child & Adolescent Psychiatry Physician
  • Idaho Falls, ID
National Provider Identifier
1346216975
Registry record updated Dec 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
M11154 Issued in ID
Practice address
2280 E 25TH Street
Idaho Falls, ID 83404
Phone
(208) 227-2295
Fax
(208) 227-2364
NPI assigned
Feb 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 5576 SD
Child & Adolescent Psychiatry Physician 2084P0804X M11154 ID Primary

Addresses

Primary practice location

2280 E 25TH Street
Idaho Falls, ID 83404

Mailing address

2280 E 25TH Street
Idaho Falls, ID 83404
Phone (208) 227-2295

Other identifiers 3

IdentifierTypeStateIssuer
13426216975MedicaidID
4994379OtherSDBCBS
7101880MedicaidSD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M11154IDMDChild & Adolescent Psychiatry Physician
5576SDMDChild & Adolescent Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centra Health, Inc. PastSince Jan 1, 1990 Accepting new patients
Centra Health Inc PastSince Jan 1, 1990 Accepting new patients
Riverbend Center for Mental Health Past Accepting new patients
Centra Health Inc PastSince Jan 1, 1990 Accepting new patients
Centra Health Inc PastSince Jan 1, 1990 Accepting new patients
Centra Health Inc PastSince Jan 1, 1990 Accepting new patients
Bridges at Farmville PastSince Jan 1, 1990 Accepting new patients
East Falls Family Medicine, LLC PastSince Mar 1, 2013 Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1346216975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2280 E 25TH STREET",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-227-2295",
            "fax_number": "208-227-2364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2280 E 25TH STREET",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-227-2295",
            "fax_number": "208-227-2364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUNNELL",
        "first_name": "SUSAN",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-24",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "SD",
            "license": "5576",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "ID",
            "license": "M11154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13426216975",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4994379",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7101880",
            "state": "SD"
        }
    ],
    "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 Dec 16, 2011; 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.