Trevor D. Tredennick, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

036-112632 Issued in IL

Practice address

1202 E Locust St
Emmett, ID 83617-2715

Phone

(208) 365-3561

NPI assigned

Aug 31, 2005

Last updated

Dec 9, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/eb237299-e2be-4fd4-aca6-5fa7adcd28c1/
• Direct secure messaging: trevort@yourcarecommunity.org
• Direct secure messaging: ttredennick@valorhealth.cernerdirect.com

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.

• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Idaho Falls, ID
  • NPI 1205300407
  Medicare reassignment NPD
• Walter Knox Memorial Hospital

  dba Valor Health

  • Critical Access Hospital
  • Emmett, ID
  • NPI 1063419018
  Medicare reassignment NPD
• Urgent Care Associates PLLC

  • Preferred Provider Organization
  • Idaho Falls, ID
  • NPI 1609046408
  NPD
• Walter Knox Memorial Hospital

  dba Valor Health

  • Specialist
  • Emmett, ID
  • NPI 1326206947
  NPD
• Walter Knox Memorial Hospital

  • Family Medicine Physician
  • Emmett, ID
  • NPI 1861284721
  NPD
• Sterling Provider Group

  • Urgent Care Clinic/Center
  • Butte, MT
  • NPI 1871220038
  NPD
• St. John's Emergency Physicians, Inc., P.S.

  • Emergency Medicine Physician
  • Longview, WA
  • NPI 1154354660
  NPD (past)
• Washington Hospital

  dba Emergency Medicine Washington Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Washington, PA
  • NPI 1639133861
  NPD (past)

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

{
    "created_epoch": "1125446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670544000000",
    "number": "1649264052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 E LOCUST ST",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836172715",
            "telephone_number": "208-365-3561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 E LOCUST ST",
            "city": "EMMETT",
            "state": "ID",
            "postal_code": "836172715",
            "telephone_number": "208-365-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREDENNICK",
        "first_name": "TREVOR",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-31",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036-112632",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8420713",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-112632",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Kelleys (Assurance Medical)
• The Smith Clinic
• Thomas W Woodward OD PC
• Kodie Thomas
• James F. Thomson, M.D.
• Trinity Counseling Ministries
• Tylers Prescription Pharmacy (Tylers Gem Pharmacy)
• Valley Family Health Care, Inc
• Valley Family Health Care, Inc
• Valley Family Health Care, Inc (Valley Family Pharmacy)

• Emergency Medicine Physician in Emmett, ID
• Providers in Emmett, ID by specialty
• Emergency Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.

Verify at the official NPI Registry.