NPIMap

Individual provider Active NPI

Brandon Lynn Miner, D.O

  • MOHS-Micrographic Surgery Physician
  • Idaho Falls, ID
National Provider Identifier
1528279189
Registry record updated Oct 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X
License
O-0568 Issued in ID
Practice address
2085 Providence Way
Idaho Falls, ID 83404-4945
Phone
(208) 525-4888
Fax
(208) 525-4885
NPI assigned
May 25, 2007
Last updated
Oct 17, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
MOHS-Micrographic Surgery Physician 207ND0101X O-0568 ID Primary

Addresses

Primary practice location

2085 Providence Way
Idaho Falls, ID 83404-4945

Mailing address

2085 Providence Way
Idaho Falls, ID 83404-4945
Phone (208) 525-4888

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100819000659 WY Practitioner - Dermatology 6507990009 Reassigns benefits to 1 organization
I20130919000050 ID Practitioner - Dermatology 6507990009 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
High Valley Dermatology and Dermatologic Surgery PLLCGroup PAC ID 1850433137, 9 clinicians
Teton Valley Health Care IncGroup PAC ID 3870744956, shared by 4 NPIs, 31 clinicians

Practice addresses (Care Compare)

2085 Providence Way
Idaho Falls, ID 83404-4945

283 N 1St St
Driggs, ID 83422-5109
Phone (208) 354-2302

37 Wintergreen Dr
Alpine, WY 83128-1001
Phone (208) 525-4888

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision57
Removal of skin lesions1488
Removal of skin cancer221
Skin biopsy180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
O-0568IDMDMOHS-Micrographic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Teton Valley Health Care Inc CurrentSince Jan 1, 2016 Accepting new patients
Teton Valley Health Care, Inc CurrentSince Jan 1, 2016 Accepting new patients
Teton Valley Health Care Inc CurrentSince Jan 1, 2016 Accepting new patients
High Valley Dermatology & Dermatologic Surgery PLLC Mohs-Micrographic Surgery CurrentSince Aug 1, 2013 Accepting new patients
High Valley Dermatology & Dermatologic Surgery, PC Mohs-Micrographic Surgery Past Accepting new patients
Teton Valley Health Care Inc Past Accepting new patients
Advanced Dermatology of Wyoming, Inc Dermatology Past Accepting new patients
Western Wyoming Dermatology & Surgery PC Mohs-Micrographic Surgery Past Accepting new patients
Medical Imaging Associates of Idaho Falls, Inc Past Accepting new patients
Premier Dermatology LTD Dermatology Past Accepting new patients

Locations

120 E Howard St
Driggs, ID 83422
Phone (208) 354-2302

283 N 1st St
Driggs, ID 83422
Phone (208) 354-2302

2085 Providence Way
Idaho Falls, ID 83404
Phone (208) 525-4888

925 S Utah Ave
Idaho Falls, ID 83402
Phone (208) 542-7190

703 Rigby Lake Dr
Rigby, ID 83442
Phone (208) 745-0200

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381968000000",
    "number": "1528279189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2085 PROVIDENCE WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044945",
            "telephone_number": "208-525-4888",
            "fax_number": "208-525-4885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2085 PROVIDENCE WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044945",
            "telephone_number": "208-525-4888",
            "fax_number": "208-525-4885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINER",
        "first_name": "BRANDON",
        "middle_name": "LYNN",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2013-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "ID",
            "license": "O-0568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.