NPIMap

Organization Active NPI

McDonald Rehab, PC

  • Physical Therapist
  • Pocatello, ID
National Provider Identifier
1497948509
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-1555 Issued in ID
Legal business name
MCDONALD REHAB, PC
Practice address
1800 Flandro Dr
Suite 190
Pocatello, ID 83202-4940
Phone
(208) 233-2248
Fax
(208) 233-0219
NPI assigned
Aug 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

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

Authorized official

Name
Mr. Bart W McDonald, MPTNPI 1043332901
Title
Owner
Phone
(208) 233-2248

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT-1555 ID Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OT-884 ID

Addresses

Primary practice location

1800 Flandro Dr
Suite 190
Pocatello, ID 83202-4940

Mailing address

1800 Flandro Dr
Suite 190
Pocatello, ID 83202-4940
Phone (208) 233-2248

Other identifiers 4

IdentifierTypeStateIssuer
7869690OtherKYAETNA
807980200MedicaidID
P00320548OtherIDBLUE SHIELD MEDICARE ADVA
T9345OtherIDBCID

Other names 1

  • Superior Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080207000254 ID Part B Supplier - Clinic/Group Practice 2163505603 Receives reassigned benefits from 20 practitioners
Practice locations: Rexburg, ID; Pocatello, ID; Idaho Falls, ID; American Falls, ID

National Provider Directory

National Provider Directory

Locations

1680 E 1st St
Idaho Falls, ID 83401
Phone (208) 417-0090

2375 E Sunnyside Rd
Ste H
Idaho Falls, ID 83404
Phone (208) 417-0090

500 S 11th Ave
Ste 506
Pocatello, ID 83201
Phone (208) 233-2248

1800 Garrett Way
Ste 19A
Pocatello, ID 83201
Phone (208) 233-1064

128 Vista Dr
Pocatello, ID 83201
Phone (208) 233-2248

136 W Main St
Rexburg, ID 83440
Phone (208) 233-2248

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441843200000",
    "number": "1497948509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR",
            "address_2": "SUITE 190",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024940",
            "telephone_number": "208-233-2248",
            "fax_number": "208-233-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR",
            "address_2": "SUITE 190",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024940",
            "telephone_number": "208-233-2248",
            "fax_number": "208-233-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCDONALD REHAB, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2015-09-10",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "BART",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-233-2248",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-1555",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-884",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7869690",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807980200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD MEDICARE ADVA",
            "identifier": "P00320548",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCID",
            "identifier": "T9345",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Superior Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.