Thomas Daniel Fife, PA-C
Individual provider Active NPI Medical Physician Assistant · Challis, ID
NPI 1689022519 · NPPES record last updated Jul 21, 2020
Key facts
- NPI
- 1689022519
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA-1371 (ID)
- Practice address
- 611 Clinic Rd
Challis, ID 83226 - Phone
- (208) 879-4351
- Fax
- (208) 879-5216
- NPI assigned
- Jun 1, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Caribou Medical Center, Inc
Community Care West Side LLC
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
- Idaho Falls Community Hospital, LLC
- Caribou Medical Center
- Mountain View Hospital
- Eastern Idaho Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161027002323 | ID | Practitioner - Physician Assistant | 2961780887 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caribou Medical Center, Inc | Current |
Accepting new patients | |
| Mountain View Hospital LLC | Current |
Accepting new patients | |
| Community Care | Current | Accepting new patients | |
| CC Pocatello LLC | Past | Accepting new patients | |
| Mountain View Hospital Physician Organization | Past | Accepting new patients |
Locations
765 S Utah Ave
Idaho Falls, ID 83402
Phone (208) 525-2600
3500 Potomac Way
#100
Idaho Falls, ID 83404
Phone (208) 522-7666
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
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA-1371 | ID | Yes |
Addresses
Primary practice location
611 Clinic Rd
Challis, ID 83226
Mailing address
611 Clinic Rd
Challis, ID 83226
Phone (208) 879-4351
Other providers in Challis, ID
- Corrigan Chiropractic PC
- Country Doctor Chartered
- John Edwards Dmochowski
- Eagles Wings Transportation
- Eagles Wings Transportation
- R Patrick Fox
- Miles Alan Haeberle
- Melissa Hardy
- Hill Speech & Language Therapy Inc.
- Kenneth Henry Hyatt
All providers in Challis, ID · Medical Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.