Fred Elmer Giovanini, L.D.

Primary specialty

DenturistTaxonomy code 122400000X

License

LD35 Issued in ID

Practice address

505 1St Street, Suite a
Idaho Falls, ID 83401

Phone

(208) 525-6002

Fax

(208) 232-2558

NPI assigned

Jul 27, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Denture Clinic Inc

  • Dental Laboratory
  • Idaho Falls, ID
  • NPI 1184169245
  NPD (past) Authorized official

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248652800000",
    "number": "1386875268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 1ST ST",
            "address_2": "SUITE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013929",
            "telephone_number": "208-525-6002",
            "fax_number": "208-232-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 1ST STREET, SUITE A",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83401",
            "telephone_number": "208-525-6002",
            "fax_number": "208-232-2558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIOVANINI",
        "first_name": "FRED",
        "middle_name": "ELMER",
        "name_prefix": "Mr.",
        "credential": "L.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-27",
        "last_updated": "2009-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "ID",
            "license": "LD35",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010009728",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREMERA BLUE CROSS",
            "identifier": "753354100000",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "GD203",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1650686",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005553418",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL OF IDAHO",
            "identifier": "0041",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002725400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mikell Brynn Gibbons
• Barrett J Gibson, DPT
• Jennaeve Gifford
• Mary Rebekah Gillespie
• Whitney Dianne Gillespie, LPC
• Philip William Girling, M.D.
• Bridget Gitthens, LMFT
• Barry Glanzer, D.C.
• Holly Mariah Glick, LMSW
• Slawomir Glowacki Jr., MD

• Denturist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Denturist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.