Advanced Orthopedics and Sports Medicine PLLC
Organization Active NPI Sports Medicine (Family Medicine) Physician · Twin Falls, ID
NPI 1508611591 · NPPES record last updated Jul 26, 2024
Key facts
- NPI
- 1508611591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Sports Medicine (Family Medicine) Physician 207QS0010X
- Legal business name
- ADVANCED ORTHOPEDICS AND SPORTS MEDICINE PLLC
- Practice address
- 1411 Falls Ave E Ste 1301
Twin Falls, ID 83301-3467 - Phone
- (208) 731-2351
- NPI assigned
- Apr 22, 2024
- Organization subpart
- No
Authorized official
- Name
- Dr. Chad Johnson, DO
- Title
- Physician/Owner
- Phone
- (208) 731-2351
Practitioners 2
-
Chad J Johnson, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240809001447 | ID | Part B Supplier - Clinic/Group Practice | 4587102470 |
Receives reassigned benefits from 2 practitioners Practice locations: Twin Falls, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician |
207QS0010X | Yes |
Addresses
Primary practice location
1411 Falls Ave E Ste 1301
Twin Falls, ID 83301-3467
Mailing address
1411 Falls Ave E Ste 1301
Twin Falls, ID 83301-3467
Other providers in Twin Falls, ID
- Adult, Child, and Family Associates
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- Advanced Drug Detection II
- Advanced Foot & Ankle of Magic Valley, LLC
- Advanced Hand Therapy PC
- Advanced Podiatry of Southern Idaho, LLC
- Aeris Pediatrics, PLLC
- Marci Ahlquist
- Jeremy Ajeti
- Akin Counseling PLLC
All providers in Twin Falls, ID · Sports Medicine (Family Medicine) Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 26, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.