NPIMap

Individual provider Active NPI

Thomas Daniel Fife, PA-C

  • Medical Physician Assistant
  • Challis, ID
National Provider Identifier
1689022519
Registry record updated Jul 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-1371 Issued in ID
Practice address
611 Clinic Rd
Challis, ID 83226
Phone
(208) 879-4351
Fax
(208) 879-5216
NPI assigned
Jun 1, 2016
Last updated
Jul 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA-1371 ID Primary

Addresses

Primary practice location

611 Clinic Rd
Challis, ID 83226

Mailing address

611 Clinic Rd
Challis, ID 83226
Phone (208) 879-4351

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161027002323 ID Practitioner - Physician Assistant 2961780887 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Caribou Medical Center, IncGroup PAC ID 7618365701, 35 clinicians
Community Care West Side LLCGroup PAC ID 3678738218, 17 clinicians

Practice addresses (Care Compare)

300 S 3Rd
Soda Springs, ID 83276-1559
Phone 20854733417503

765 S Utah Ave
Idaho Falls, ID 83402-5093
Phone (208) 585-2600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Caribou Medical Center, Inc CurrentSince May 1, 2025 Accepting new patients
Emergency Physicians Integrated Care, LLC CurrentSince Mar 1, 2025 Accepting new patients
Mountain View Hospital LLC CurrentSince Oct 1, 2024 Accepting new patients
Community Care Current Accepting new patients
Caribou Medical Center, Inc CurrentSince May 1, 2025 Accepting new patients
Mountain View Hospital Physician Organization Past Accepting new patients
CC Pocatello LLC Past Accepting new patients

Locations

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

2327 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-1000

2725 Channing Way
Idaho Falls, ID 83404
Phone (208) 525-8448

2730 Channing Way
Idaho Falls, ID 83404
Phone (208) 542-7100

3500 Potomac Way
#100
Idaho Falls, ID 83404
Phone (208) 522-7666

765 S Utah Ave
Idaho Falls, ID 83402
Phone (208) 525-2600

1595 Yellowstone Ave
Pocatello, ID 83201
Phone (208) 233-0032

404 N 2nd E
Rexburg, ID 83440
Phone (208) 359-1770

167 E 1st S
Rigby, ID 83442
Phone (208) 745-8747

300 S 3rd W
Soda Springs, ID 83276
Phone (208) 547-0700

Organizations & group practices 9

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 4

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": "1464739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595289600000",
    "number": "1689022519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 CLINIC RD",
            "city": "CHALLIS",
            "state": "ID",
            "postal_code": "83226",
            "telephone_number": "208-879-4351",
            "fax_number": "208-879-5216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 CLINIC RD",
            "city": "CHALLIS",
            "state": "ID",
            "postal_code": "83226",
            "telephone_number": "208-879-4351",
            "fax_number": "208-879-5216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIFE",
        "first_name": "THOMAS",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-01",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Challis, ID

Sources for this page

Verify at the official NPI Registry.