Active NPI
Mark B Rencher, MD
- Family Medicine Physician
- Idaho Falls, ID
National Provider Identifier
1649385386
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- M4486
- Practice address
- 2610 Channing Way
Idaho Falls, ID 83404 - Phone
- (208) 523-0888
- Fax
- (208) 523-0968
- NPI assigned
- Aug 21, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M4486 | ID | Primary |
Addresses
Primary practice location
2610 Channing Way
Idaho Falls, ID 83404
Mailing address
1751 Revere Way
Eagle Mountain, UT 84005-5147
Phone (801) 995-1951
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010000652 | Other | ID | BLUE SHIELD |
| 002543500 | Medicaid | ID | |
| 44867 | Other | ID | BLUE CROSS |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4486 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain View Hospital LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1669462362
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1224460800000",
"number": "1649385386",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1751 REVERE WAY",
"city": "EAGLE MOUNTAIN",
"state": "UT",
"postal_code": "840055147",
"telephone_number": "801-995-1951",
"fax_number": "801-995-1951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2610 CHANNING WAY",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "83404",
"telephone_number": "208-523-0888",
"fax_number": "208-523-0968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENCHER",
"first_name": "MARK",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2008-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ID",
"license": "M4486",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010000652",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002543500",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "44867",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.