Individual provider Active NPI

Shaun J Westergard, PA

  • Physician Assistant
  • Idaho Falls, ID
National Provider Identifier
1740461102
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-710 Issued in ID
Practice address
2001 S Woodruff Ave Ste 9
Idaho Falls, ID 83404-6371
Phone
(208) 419-3002
Fax
(208) 656-5652
NPI assigned
Nov 14, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA710 ID
Physician Assistant 363A00000X PA-710 ID Primary

Addresses

Primary practice location

2001 S Woodruff Ave Ste 9
Idaho Falls, ID 83404-6371

Mailing address

2001 S Woodruff Ave Ste 9
Idaho Falls, ID 83404-6371
Phone (208) 419-3002

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071205000256 ID Practitioner - Physician Assistant 7113016734 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascend LLCGroup PAC ID 5496179574, 8 clinicians

Practice addresses (Care Compare)

2001 S Woodruff Ave
Suite 9
Idaho Falls, ID 83404-6371
Phone (208) 419-3002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-710IDMDPhysician Assistant
PA710IDMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Hospital LLC CurrentSince Jun 20, 2014 Accepting new patients
Sterling Provider Group CurrentSince Aug 10, 2019 Accepting new patients
Urgent Care Associates PLLC Current Accepting new patients
Sterling Provider Group CurrentSince Aug 10, 2019 Accepting new patients
Community Council of Idaho, Inc. Past Accepting new patients
Community Council of Idaho, Inc. Past Accepting new patients

Locations

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

3425 Potomac Way
Idaho Falls, ID 83404
Phone (208) 528-8170

740 S Woodruff Ave
Idaho Falls, ID 83401
Phone (208) 542-9111

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1740461102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 9",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046371",
            "telephone_number": "208-419-3002",
            "fax_number": "208-656-5652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 9",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046371",
            "telephone_number": "208-419-3002",
            "fax_number": "208-656-5652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WESTERGARD",
        "first_name": "SHAUN",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-14",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA710",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.