Individual provider Active NPI

Larry Craig Evans, D.O.

  • Gastroenterology Physician
  • Idaho Falls, ID
National Provider Identifier
1669540522
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
O-0468 Issued in ID
Practice address
2770 Cortez Ave
Idaho Falls, ID 83404-7590
Phone
(208) 522-4000
Fax
(208) 528-4254
NPI assigned
Nov 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X O-0468 ID Primary

Addresses

Primary practice location

2770 Cortez Ave
Idaho Falls, ID 83404-7590

Mailing address

2770 Cortez Ave
Idaho Falls, ID 83404-7590
Phone (208) 522-4000

Other identifiers 1

IdentifierTypeStateIssuer
808040300MedicaidID

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
I20080612000115 ID Practitioner - GastroenterologyPractitioner - Internal Medicine 9133105646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy104
Upper gastrointestinal (GI) endoscopy for acid reflux139

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Hospital LLC CurrentSince Oct 15, 2022 Accepting new patients
Genesys Integrated Group Practice PC Past Accepting new patients
Mountain View Hospital Physician Organization Past Accepting new patients

Locations

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

2770 Cortez Ave
Idaho Falls, ID 83404
Phone (208) 522-4000

Interoperability endpoints

  • Direct secure messaging: larry.evans@synapse.cernerdirect.com

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376438400000",
    "number": "1669540522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 CORTEZ AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047590",
            "telephone_number": "208-522-4000",
            "fax_number": "208-528-4254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 CORTEZ AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047590",
            "telephone_number": "208-522-4000",
            "fax_number": "208-528-4254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "LARRY",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2013-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ID",
            "license": "O-0468",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808040300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.