Active NPI
Bryce D Hanson, D.M.D
- Dentist
- Shelley, ID
National Provider Identifier
1629027099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D-3275
- Practice address
- 371 W Fir St
Shelley, ID 83274-1456 - Phone
- (208) 357-7611
- Fax
- (208) 357-1805
- NPI assigned
- May 10, 2006
- Last updated
- Oct 12, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D-3275 | ID | Primary |
Addresses
Primary practice location
371 W Fir St
Shelley, ID 83274-1456
Mailing address
PO Box 525
371 W.Fir
Shelley, ID 83274-0525
Phone (208) 357-7611
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 805031700 | Medicaid | ID |
Medicare participation
Medicare enrollment files- 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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150904002270 | ID | Order and Referring Only - Dentist | 2264748227 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-3275 | ID | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Steven F Nielsen DDS PA | Dentist | Past | Accepting new patients |
| Bryce D Hanson, DMD PA | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697068800000",
"number": "1629027099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 525",
"address_2": "371 W.FIR",
"city": "SHELLEY",
"state": "ID",
"postal_code": "832740525",
"telephone_number": "208-357-7611",
"fax_number": "208-357-1805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "371 W FIR ST",
"city": "SHELLEY",
"state": "ID",
"postal_code": "832741456",
"telephone_number": "208-357-7611",
"fax_number": "208-357-1805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSON",
"first_name": "BRYCE",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-10",
"last_updated": "2023-10-12",
"certification_date": "2023-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D-3275",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805031700",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shelley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.