Brodi Smith DO PLLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

O1114 Issued in ID

Legal business name

BRODI SMITH DO PLLC

Doing business as

Idaho Falls Surgical Specialists

Practice address

2805 Valencia Dr
Idaho Falls, ID 83404-7597

Phone

(208) 525-9400

Fax

(208) 525-6151

NPI assigned

May 30, 2018

Organization subpart

No

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

Authorized official

Name

Brodi Smith, DONPI 1447690904

Title

DO

Phone

(515) 423-6125

Specialties & licenses 1

Addresses

Other names 1

• Idaho Falls Surgical Specialists Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 1

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

• Brodi Smith, DO

  • Surgery Physician
  • Idaho Falls, ID
  • NPI 1447690904
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1527638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1659863207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 VALENCIA DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047597",
            "telephone_number": "208-525-9400",
            "fax_number": "208-525-6151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 VALENCIA DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047597",
            "telephone_number": "208-525-9400",
            "fax_number": "208-525-6151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRODI SMITH DO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-30",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BRODI",
        "authorized_official_title_or_position": "DO",
        "authorized_official_telephone_number": "515-423-6125",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "ID",
            "license": "O1114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Falls Surgical Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Carrie Bronson
• Cornelius Paul Brooke, MD
• Broulim Supermarkets, LLC
• Jamie Renee Brower, PHARM, D
• David Kelly Brown, DO

• Surgery Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.