Audra J Rose, PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

M6628 Issued in ID

Practice address

3450 Potomac Way
Idaho Falls, ID 83404-7407

Phone

(208) 557-2900

Fax

(208) 557-2910

NPI assigned

Apr 10, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Audra J Rose Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Women'S Healthcare Associates, P.a.Group PAC ID 3577540616, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Women'S Healthcare Associates, P.a.

  • Obstetrics & Gynecology Physician
  • Idaho Falls, ID
  • NPI 1255400636
  Medicare reassignment Care Compare group
• Angel Wings Center of Healing

  • Clinical Social Worker
  • Idaho Falls, ID
  • NPI 1215159819
  NPD (past)

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

• Eastern Idaho Health Services Inc

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1487877619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 POTOMAC WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044970",
            "telephone_number": "208-557-2900",
            "fax_number": "208-557-2910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 POTOMAC WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "208-557-2900",
            "fax_number": "208-557-2910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "AUDRA",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "TL403",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "M6628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807761500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDRA",
            "last_name": "ROSE",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Romaines Mattress King Inc
• Eric Romrell, LMSW
• Eric K Romriell, DO
• Karen Marie Ronneberg, MSW
• Root & Branch Anesthesia P.L.L.C.
• Chandler Rose, P.T.
• Glenn Rose, LSW1887
• Beth Roth
• Kelsi Delora Rounds, FNP
• Adam David Rowbury, BS CADC

• Obstetrics & Gynecology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Obstetrics & Gynecology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.