Individual provider Active NPI

Dwayne M Hansen, M.D.

  • Surgery Physician
  • Rexburg, ID
National Provider Identifier
1376581546
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
M8427 Issued in ID
Practice address
381 East 4TH North
Ste 100
Rexburg, ID 83440
Phone
(208) 656-8442
Fax
(208) 656-8453
NPI assigned
Jun 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X M8427 ID Primary

Addresses

Primary practice location

381 East 4TH North
Ste 100
Rexburg, ID 83440

Mailing address

PO Box 185
Rexburg, ID 83440-0185
Phone (208) 656-8442

Other identifiers 3

IdentifierTypeStateIssuer
48488OtherIDBLUE CROSS OF IDAHO
CS9440OtherIDIDAHO STATE BOARD OF PHAR
M8427OtherIDIDAHO STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040930000782 ID Practitioner - General Surgery 1951370402 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Tulane University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

381 E 4TH
Suite 100
Rexburg, ID 83440-1684
Phone (208) 656-8442

Hospital & facility affiliations

  • Madison Memorial Hospital Hospital, Rexburg, ID, CCN 130025
  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Teton Valley Hospital Hospital, Driggs, ID, CCN 131313

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy44
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux25
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M8427IDMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dwayne M. Hansen MD PLLC Surgery CurrentSince Jul 1, 2002 Accepting new patients
Max Hansen Surgery PLLC Surgery PastSince Mar 20, 2022 Accepting new patients
Rexburg Surgery Center LLC PastSince Jun 1, 2006 Accepting new patients

Locations

381 E 4th N
#100
Rexburg, ID 83440
Phone (208) 359-1888

Organizations & group practices 3

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1376581546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 185",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834400185",
            "telephone_number": "208-656-8442",
            "fax_number": "208-656-8453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "381 EAST 4TH NORTH",
            "address_2": "STE 100",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "83440",
            "telephone_number": "208-656-8442",
            "fax_number": "208-656-8453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSEN",
        "first_name": "DWAYNE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M8427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "48488",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO STATE BOARD OF PHAR",
            "identifier": "CS9440",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO STATE LICENSE",
            "identifier": "M8427",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.