Organization Active NPI

Empower PT, PLLC

  • Orthopedic Physical Therapist
  • Idaho Falls, ID
National Provider Identifier
1538763370
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Legal business name
EMPOWER PT, PLLC
Practice address
804 Pancheri Dr
Idaho Falls, ID 83402-3344
Phone
(208) 403-7422
NPI assigned
Nov 23, 2020
Last updated
Nov 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Authorized official

Name
Jordan Stoddard, DPTNPI 1073115382
Title
Owner
Phone
(208) 403-7422

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
Sports Physical Therapist 2251S0007X
Orthopedic Physical Therapist 2251X0800X Primary

Addresses

Primary practice location

804 Pancheri Dr
Idaho Falls, ID 83402-3344

Mailing address

3716 E 343 N
Rigby, ID 83442-5326
Phone (208) 403-7422

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210430000335 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2365851540 Receives reassigned benefits from 3 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Locations

804 Pancheri Dr
Idaho Falls, ID 83402
Phone (208) 403-7422

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1538763370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3716 E 343 N",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425326",
            "telephone_number": "208-403-7422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 PANCHERI DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023344",
            "telephone_number": "208-403-7422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMPOWER PT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "STODDARD",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-403-7422",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; 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.