John Dustin Pena, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

65855 Issued in ID

Practice address

403 Riverfront Dr
Salmon, ID 83467-5162

Phone

(208) 742-1110

Fax

(208) 742-1120

NPI assigned

Oct 14, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Salmon River ClinicGroup PAC ID 4587941620, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Steele Memorial Medical Center Hospital, Salmon, ID, CCN 131305
• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Interoperability endpoints

• Direct secure messaging: john.pena.1@15946.direct.athenahealth.com

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.

• Salmon River Clinic

  • Primary Care Clinic/Center
  • Salmon, ID
  • NPI 1104351972
  Medicare reassignment Care Compare group
• Salmon River Clinic Hospital District

  • Family Medicine Physician
  • Stanley, ID
  • NPI 1083796569
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastern Idaho Health Services Inc

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation
• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Care Compare affiliation
• Steele Memorial Medical Center

  • Critical Access Hospital
  • Salmon, ID
  • NPI 1851403265
  Care Compare affiliation

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

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728345600000",
    "number": "1730787482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 RIVERFRONT DR",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834675162",
            "telephone_number": "208-742-1110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 RIVERFRONT DR",
            "city": "SALMON",
            "state": "ID",
            "postal_code": "834675162",
            "telephone_number": "208-742-1110",
            "fax_number": "208-742-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA",
        "first_name": "JOHN",
        "middle_name": "DUSTIN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-14",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "65855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard M Natelson, MD
• Suzanne Nebeker, NP
• Mark S Oliverson, DMD
• Rachel Pearson, LPC
• Kylie Peets
• Coleen Baird Phelps, LPC
• Kelly C Phelps, MD
• Physical Therapy Clinic,Inc.
• Porgy and Petunia Pediatric Therapy
• Lance Wesley Port, PA-C

• Family Nurse Practitioner in Salmon, ID
• Providers in Salmon, ID by specialty
• Family Nurse Practitioner in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.