Grand Teton Child Neurology

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

Legal business name

GRAND TETON CHILD NEUROLOGY

Practice address

2225 Teton PLZ Ste B
Idaho Falls, ID 83404-6494

Phone

(208) 529-4300

Fax

(208) 529-1627

NPI assigned

Oct 28, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Peter W Castellanos, MDNPI 1811991474

Title

Neurologist

Phone

(208) 529-4300

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

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

• Peter W Castellanos, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Idaho Falls, ID
  • NPI 1811991474
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629158400000",
    "number": "1639322258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2225 TETON PLZ STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046494",
            "telephone_number": "208-529-4300",
            "fax_number": "208-881-5121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 TETON PLZ STE B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046494",
            "telephone_number": "208-529-4300",
            "fax_number": "208-529-1627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TETON CHILD NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2021-08-17",
        "certification_date": "2021-08-17",
        "status": "A",
        "authorized_official_last_name": "CASTELLANOS",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "NEUROLOGIST",
        "authorized_official_telephone_number": "208-529-4300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "77234",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807968700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katey Lynn Gott, LSW27130
• Kaylee Louise Gould
• Steele Gould
• Sara Graham, RN
• Zebulon C Graham, PHARMD
• Grand Teton Chiropractic, P.C.
• Grand Teton Chiropractic, PLLC
• Grand Teton Gastroenterology
• Grand Teton Gastroenterology, PA
• Grand Teton Service Group

• Neurology with Special Qualifications in Child Neurology Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2021; 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.