NPIMap

Organization Active NPI

Teton Vascular Institute of Pocatello a Series of Teton Group

  • Vascular & Interventional Radiology Physician
  • Pocatello, ID
National Provider Identifier
1508224379
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
TETON VASCULAR INSTITUTE OF POCATELLO A SERIES OF TETON GROUP
Practice address
444 Hospital Way BLDG 100
Ste 111
Pocatello, ID 83201-2745
Phone
(208) 232-8346
Fax
(208) 233-2272
NPI assigned
Feb 8, 2016
Last updated
Jan 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Authorized official

Name
Mr. Michael P Hodel
Title
Ceo
Phone
(208) 542-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X NU Primary

Addresses

Primary practice location

444 Hospital Way BLDG 100
Ste 111
Pocatello, ID 83201-2745

Mailing address

PO Box 30015
Dept 596
Salt Lake City, UT 84130-0015
Phone (800) 475-6236

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, MT, WY, UT, TX5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20160409000003 ID Part B Supplier - Clinic/Group Practice 8921306846 Receives reassigned benefits from 41 practitioners
Practice locations: Montpelier, ID; Blackfoot, ID; Soda Springs, ID; Salmon, ID; Rupert, ID; Rexburg, ID; Preston, ID; Pocatello, ID…
O20231027001079 MT Part B Supplier - Clinic/Group Practice 8921306846 Receives reassigned benefits from 31 practitioners
Practice locations: Deer Lodge, MT
O20231030000507 WY Part B Supplier - Clinic/Group Practice 8921306846 Receives reassigned benefits from 31 practitioners
Practice locations: Afton, WY; Lander, WY; Rawlins, WY; Riverton, WY; Rock Springs, WY
O20231106000803 UT Part B Supplier - Clinic/Group Practice 8921306846 Receives reassigned benefits from 22 practitioners
Practice locations: Logan, UT; Providence, UT
O20240724002674 TX Part B Supplier - Clinic/Group Practice 8921306846 Receives reassigned benefits from 2 practitioners
Practice locations: Corpus Christi, TX; Vidor, TX

National Provider Directory

National Provider Directory

Locations

2001 S Woodruff Ave
Idaho Falls, ID 83404
Phone (208) 523-2060

2221 Elm St
Rawlins, WY 82301
Phone (307) 324-2221

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1454889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767571200000",
    "number": "1508224379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30015",
            "address_2": "DEPT 596",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841300015",
            "telephone_number": "800-475-6236",
            "fax_number": "706-596-6712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 HOSPITAL WAY BLDG 100",
            "address_2": "STE 111",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012745",
            "telephone_number": "208-232-8346",
            "fax_number": "208-233-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON VASCULAR INSTITUTE OF POCATELLO A SERIES OF TETON GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-08",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A",
        "authorized_official_last_name": "HODEL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-542-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jan 5, 2026; 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.