Individual provider Active NPI

Kwadwo Antwi Saka, MD

  • Student in an Organized Health Care Education/Training Program
  • Idaho Falls, ID
National Provider Identifier
1356089098
Registry record updated Jul 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
2001 S Woodruff Ave Ste 9
Idaho Falls, ID 83404-6371
Phone
(208) 419-3002
NPI assigned
May 23, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X M-17848 ID
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

2001 S Woodruff Ave Ste 9
Idaho Falls, ID 83404-6371

Mailing address

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone (208) 970-4091

Other practice location 1

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone (208) 970-4091

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240903001147 ID Practitioner - Psychiatry 6406237874 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pearl Health Clinic CurrentSince Aug 26, 2024 Accepting new patients
Ascend LLC Psychiatry CurrentSince Jul 7, 2024 Accepting new patients

Locations

2705 E 17th St
Ammon, ID 83406

2001 S Woodruff Ave
Ste 9
Idaho Falls, ID 83404
Phone (208) 419-3002

500 S 11th Ave
Ste 203
Pocatello, ID 83201
Phone (208) 232-5902

Organizations & group practices 2

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": "1653264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719964800000",
    "number": "1356089098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "208-970-4091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 9",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046371",
            "telephone_number": "208-419-3002"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 Channing Way",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834047533",
            "country_code": "US",
            "telephone_number": "208-970-4091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAKA",
        "first_name": "KWADWO",
        "middle_name": "ANTWI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-23",
        "last_updated": "2024-07-03",
        "certification_date": "2024-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-17848",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.