Kory Andersen
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · 207514, ID
NPI 1497514889 · NPPES record last updated Jun 25, 2024
Key facts
- NPI
- 1497514889
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 3100 Channing Way
Idaho Falls
207514, ID 83404 - Phone
- (208) 529-6111
- NPI assigned
- Mar 18, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240904004389 | ID | Order and Referring Only - Family Practice |
3779023858 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Interoperability endpoints
- kory.andersen.1@16437.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
3100 Channing Way
Idaho Falls
207514, ID 83404
Mailing address
3100 Channing Way
Idaho Falls, ID 83404-7533
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.