Active NPI
Kylan D Peterson, D.O.
- Otolaryngology/Facial Plastic Surgery Physician
- Twin Falls, ID
National Provider Identifier
1750542452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology/Facial Plastic Surgery Physician
- License
- O0713
- Practice address
- 730 N College Rd
Suite B
Twin Falls, ID 83301-3382 - Phone
- (208) 814-7350
- Fax
- (208) 732-8508
- NPI assigned
- Jun 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology/Facial Plastic Surgery Physician | 207YX0905X | O0713 | ID | Primary |
Addresses
Primary practice location
730 N College Rd
Suite B
Twin Falls, ID 83301-3382
Mailing address
PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130802000550 | ID | Practitioner - Otolaryngology | 6608061676 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Otolaryngology
- Education
- At Still University of Health Sciences, College of Osteo Med, Kirksville, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2102 Canyon Plaza Dr
Twin Falls, ID 83301-4513
Phone (208) 804-1717
Hospital & facility affiliations
- St Lukes Magic Valley Medical Center
- St Luke'S Wood River Medical Center
- Cassia Regional Hospital
- St Luke'S Regional Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 85.09 of 100
- Quality
- 77.1
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.19
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O0713 | ID | MD | Otolaryngology/Facial Plastic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gem State ENT, PLLC | Current | Accepting new patients | |
| St Luke'S Clinic LLC | Current | Accepting new patients | |
| Paramount Surgical Services LLC | Current | Accepting new patients | |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients | |
| Genesys Integrated Group Practice PC | Past | Accepting new patients |
Locations
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
1501 Hiland Ave
Ste M
Burley, ID 83318
Phone (208) 352-7555
314 S River St
Hailey, ID 83333
Phone (208) 450-5645
730 N College Rd
#B
Twin Falls, ID 83301
Phone (208) 732-3066
746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230
801 Pole Line Rd W
Twin Falls, ID 83301
Phone (208) 814-1000
625 Pole Line Rd W
Ste 2B
Twin Falls, ID 83301
Phone (208) 814-5300
Interoperability endpoints
- kpeterson38976@direct.slhs.org
Organizations & group practices 5
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.
-
- Family Medicine Physician
- Twin Falls, ID
- NPI 1790718229
-
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
-
- Nurse Practitioner
- Flint, MI
- NPI 1386782381
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Twin Falls, ID
- NPI 1932154705
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420156800000",
"number": "1750542452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 587",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833030587",
"telephone_number": "208-814-7400",
"fax_number": "208-814-7491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "730 N COLLEGE RD",
"address_2": "SUITE B",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833013382",
"telephone_number": "208-814-7350",
"fax_number": "208-732-8508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "KYLAN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-24",
"last_updated": "2015-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "207YX0905X",
"taxonomy_group": "",
"desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
"state": "ID",
"license": "O0713",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; 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.