NPIMap

Individual provider Active NPI

Douglas Ken Andersen, DO

  • Internal Medicine Physician
  • Pocatello, ID
National Provider Identifier
1730599598
Registry record updated Oct 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
6352 Issued in OK
Practice address
777 Hospital Way
Pocatello, ID 83201-5175
Phone
(208) 239-1720
Fax
(208) 239-1726
NPI assigned
May 2, 2014
Last updated
Oct 27, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 6352 OK Primary

Addresses

Primary practice location

777 Hospital Way
Pocatello, ID 83201-5175

Mailing address

10109 E. 79TH Street
Tulsa, OK 74133
Phone (918) 286-5000

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
I20200807001646 ID Practitioner - Medical Oncology 8426327560 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
Michigan State University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Caribou Memorial HospitalGroup PAC ID 6103734777, 15 clinicians
Caribou Medical Center, IncGroup PAC ID 7618365701, 35 clinicians
Pocatello Health Services LLCGroup PAC ID 6608927637, 171 clinicians

Practice addresses (Care Compare)

300 S 3Rd
Soda Springs, ID 83276-1559

777 Hospital Way
Pocatello, ID 83201-5175
Phone (208) 239-1720

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Health Services, LLC CurrentSince Jul 31, 2020 Accepting new patients
Pocatello Health Services, LLC CurrentSince Jul 31, 2020 Accepting new patients
Caribou Medical Center, Inc CurrentSince Feb 1, 2023 Accepting new patients
Oneida County Hospital CurrentSince Jan 1, 2026 Accepting new patients
Oneida County Hospital CurrentSince Jan 1, 2026 Accepting new patients
Pocatello Health Services, LLC Current Accepting new patients
Caribou Medical Center, Inc CurrentSince Feb 1, 2023 Accepting new patients
Oneida County Hospital Physicians Group Past Accepting new patients
Pocatello Hospital LLC Internal Medicine Past Accepting new patients

Locations

150 N 200 W
Malad City, ID 83252
Phone (208) 766-2231

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640

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

Interoperability endpoints

  • Direct secure messaging: dandersen289797@ahs.direct-ci.com
  • Direct secure messaging: douglas.anderson.p4@direct.ctca-clinic.nextgenshare.com

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 6

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": "1398988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1730599598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10109 E. 79TH STREET",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "74133",
            "telephone_number": "918-286-5000",
            "fax_number": "918-249-7514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-239-1720",
            "fax_number": "208-239-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "DOUGLAS",
        "middle_name": "KEN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-02",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "6352",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.