NPIMap

Organization Active NPI

Anthony J Anderson MD & Assoc LLC

  • Family Medicine Physician
  • Burley, ID
National Provider Identifier
1558604231
Registry record updated Mar 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-11018 Issued in ID
Legal business name
ANTHONY J ANDERSON MD & ASSOC LLC
Practice address
1404 Pomerelle Ave Ste B
Burley, ID 83318-2013
Phone
(208) 878-9432
Fax
(208) 878-4576
NPI assigned
Apr 1, 2013
Last updated
Mar 18, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2016

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

Authorized official

Name
Anthony Judd Anderson, MDNPI 1508021726
Title
Owner
Phone
(208) 878-9432

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X M-11018 ID Primary

Addresses

Primary practice location

1404 Pomerelle Ave Ste B
Burley, ID 83318-2013

Mailing address

1404 Pomerelle Ave Ste B
Burley, ID 83318-2013
Phone (208) 878-9432

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160421002366 ID Part B Supplier - Clinic/Group Practice 5597064709 Receives reassigned benefits from 4 practitioners
Practice locations: Burley, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1364774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458259200000",
    "number": "1558604231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1404 POMERELLE AVE STE B",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182013",
            "telephone_number": "208-878-9432",
            "fax_number": "208-878-4576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1404 POMERELLE AVE STE B",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182013",
            "telephone_number": "208-878-9432",
            "fax_number": "208-878-4576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHONY J ANDERSON MD & ASSOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-01",
        "last_updated": "2016-03-18",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JUDD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-878-9432",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-11018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; 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.