NPIMap

Organization Active NPI

Intermountain Anesthesia Associates PLLC

  • Certified Registered Nurse Anesthetist
  • Lewiston, ID
National Provider Identifier
1609413343
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
INTERMOUNTAIN ANESTHESIA ASSOCIATES PLLC
Practice address
318 Warner Dr
Lewiston, ID 83501-4441
Phone
(208) 298-1050
NPI assigned
Dec 2, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

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

Authorized official

Name
Dustin Elben, CRNANPI 1376976456
Title
President
Phone
(509) 552-6666

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
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

318 Warner Dr
Lewiston, ID 83501-4441

Mailing address

PO Box 84702
Seattle, WA 98124-6002
Phone (877) 746-7090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200210002334 ID Part B Supplier - Clinic/Group Practice 2264868389 Receives reassigned benefits from 8 practitioners
Practice locations: Lewiston, ID

National Provider Directory

National Provider Directory

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1575244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1609413343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84702",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981246002",
            "telephone_number": "877-746-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 WARNER DR",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014441",
            "telephone_number": "208-298-1050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN ANESTHESIA ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-02",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "ELBEN",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-552-6666",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 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.