Ariel Shantay Avis Taysom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1656 Issued in ID

Practice address

220 Bannock St
Malad City, ID 83252-5068

Phone

(208) 766-2600

Fax

(208) 766-4258

NPI assigned

Oct 11, 2018

Last updated

Nov 16, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

CC Pocatello LLCGroup PAC ID 8527353176, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ataysom278438@ahs.direct-ci.com

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.

• CC Pocatello LLC

  dba Community Care Pocatello

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1538517156
  Medicare reassignment Care Compare group
• Cardiovascular Specialists of America, LLC

  • Clinical Cardiac Electrophysiology Physician
  • Pocatello, ID
  • NPI 1871190215
  Medicare reassignment
• Community Care Pocatello PLLC

  • Urgent Care Clinic/Center
  • Pocatello, ID
  • NPI 1265714760
  NPD

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

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Rehabilitation Center

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1609341098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 BANNOCK ST",
            "city": "MALAD CITY",
            "state": "ID",
            "postal_code": "832525068",
            "telephone_number": "208-766-2600",
            "fax_number": "208-766-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BANNOCK ST",
            "city": "MALAD CITY",
            "state": "ID",
            "postal_code": "832525068",
            "telephone_number": "208-766-2600",
            "fax_number": "208-766-4258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYSOM",
        "first_name": "ARIEL",
        "middle_name": "SHANTAY AVIS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-11",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1656",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ehr-direct@oneidacountyclinic.hin.us",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "220 Bannock St",
            "city": "Malad City",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832525068",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nacona N Smith
• Southeastern Idaho Medical Clinics (Malad Valley Clinic)
• William Brad Speakman, D.O.
• Dallas R Spencer, LMSW
• Summit Creek Counseling LLC
• Edgar Blair Thorpe, DDS
• Valley View Counseling LLC
• Russell Lynn Vollmer, LCSW
• Micah Weber, PT, DPT
• Joshua Price Wray

• Physician Assistant in Malad City, ID
• Providers in Malad City, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.