Individual provider Active NPI

Bryce Elwin Anderson

  • Emergency Medicine Physician
  • Glen Dale, WV
National Provider Identifier
1639706591
Registry record updated Jun 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
31944 Issued in WV
Practice address
800 Wheeling Ave
Glen Dale, WV 26038-1697
Phone
(048) 453-2113
Fax
(304) 843-3202
NPI assigned
Mar 23, 2020
Last updated
Jun 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X M-17103 ID
Emergency Medicine Physician 207P00000X 31944 WV Primary

Addresses

Primary practice location

800 Wheeling Ave
Glen Dale, WV 26038-1697

Mailing address

PO Box 9149
Morgantown, WV 26506-9149
Phone (304) 293-2436

Other practice location 1

1 Medical Center Dr
Morgantown, WV 26506-1200
Phone (304) 293-2436

Other practice location 2

1224 8th St
Rupert, ID 83350-1599
Phone (208) 436-0481

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230413000856 ID Practitioner - Emergency Medicine 5496127318 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America LLCGroup PAC ID 6608056171, 995 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

777 Hospital Way
Pocatello, ID 83201-5175
Phone (208) 239-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-17103IDMDEmergency Medicine Physician
31944WVMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Minidoka Memorial Hospital Emergency Medicine CurrentSince Jun 1, 2024 Accepting new patients
Minidoka Memorial Hospital CurrentSince Jun 1, 2024 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Jul 1, 2024 Accepting new patients
Cep America, LLC Emergency Medicine CurrentSince Jul 1, 2024 Accepting new patients
Rocky Mountain Physician Group LLC Emergency Medicine CurrentSince Mar 29, 2023 Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

1224 8th St
Rupert, ID 83350
Phone (208) 434-8236

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1639706591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9149",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265069149",
            "telephone_number": "304-293-2436",
            "fax_number": "304-293-6702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 WHEELING AVE",
            "city": "GLEN DALE",
            "state": "WV",
            "postal_code": "260381697",
            "telephone_number": "048-453-2113",
            "fax_number": "304-843-3202"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265061200",
            "country_code": "US",
            "telephone_number": "304-293-2436",
            "fax_number": "304-293-6702",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1224 8th St",
            "address_purpose": "LOCATION",
            "city": "Rupert",
            "state": "ID",
            "postal_code": "833501599",
            "country_code": "US",
            "telephone_number": "208-436-0481",
            "fax_number": "208-436-6038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "BRYCE",
        "middle_name": "ELWIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-17103",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WV",
            "license": "31944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Dale, WV

Sources for this page

Verify at the official NPI Registry.