Individual provider Active NPI

Dennis R Sawyer, P.A.-C

  • Physician Assistant
  • Twin Falls, ID
National Provider Identifier
1619909280
Registry record updated Sep 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA471 Issued in ID
Practice address
775 Pole Line Rd W
Suite 112
Twin Falls, ID 83301-5814
Phone
(208) 814-8200
Fax
(208) 933-4921
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA471 ID Primary

Addresses

Primary practice location

775 Pole Line Rd W
Suite 112
Twin Falls, ID 83301-5814

Mailing address

PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400

Other identifiers 2

IdentifierTypeStateIssuer
P00390642OtherIDRR MEDICARE
806765700MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA471IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Magic Valley Regional Medical Center Past Accepting new patients
St Luke'S Magic Valley Regional Medical Center LTD Past Accepting new patients

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1619909280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 112",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8200",
            "fax_number": "208-933-4921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAWYER",
        "first_name": "DENNIS",
        "middle_name": "R",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00390642",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806765700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.