NPIMap

Organization Active NPI

Eagle Rock Regional Neurology, P.C.

  • Neurology Physician
  • Idaho Falls, ID
National Provider Identifier
1710053756
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
O343 Issued in ID
Legal business name
EAGLE ROCK REGIONAL NEUROLOGY, P.C.
Practice address
1995 E 17TH St
Ste 5
Idaho Falls, ID 83404-6493
Phone
(208) 552-5700
Fax
(208) 552-5703
NPI assigned
Nov 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. William Karl Domarad, D.O.NPI 1831108455
Title
Physician
Phone
(208) 552-5700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X O343 ID Primary

Addresses

Primary practice location

1995 E 17TH St
Ste 5
Idaho Falls, ID 83404-6493

Mailing address

1995 E 17TH St
Ste 5
Idaho Falls, ID 83404-6493
Phone (208) 552-5700

Other identifiers 1

IdentifierTypeStateIssuer
S5247OtherIDBLUE CROSS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710053756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1995 E 17TH ST",
            "address_2": "STE 5",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046493",
            "telephone_number": "208-552-5700",
            "fax_number": "208-552-5703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 E 17TH ST",
            "address_2": "STE 5",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046493",
            "telephone_number": "208-552-5700",
            "fax_number": "208-552-5703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ROCK REGIONAL NEUROLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DOMARAD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "KARL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "208-552-5700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ID",
            "license": "O343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "S5247",
            "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.