NPIMap

Organization Active NPI

Precision Family Medicine & Aesthetics LLC

  • Primary Care Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1760119986
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PRECISION FAMILY MEDICINE & AESTHETICS LLC
Practice address
2001 S Woodruff Ave Ste 11
Idaho Falls, ID 83404-6372
Phone
(208) 757-1000
NPI assigned
Aug 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Mr. Bradley Radford, FNP-BCNPI 1871191254
Title
Owner
Phone
(208) 419-3271

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
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

2001 S Woodruff Ave Ste 11
Idaho Falls, ID 83404-6372

Mailing address

2001 S Woodruff Ave Ste 11
Idaho Falls, ID 83404-6372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221011001923 ID Part B Supplier - Clinic/Group Practice 4880060185 Receives reassigned benefits from 3 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Locations

2001 S Woodruff Ave
Ste 11
Idaho Falls, ID 83404
Phone (208) 206-0599

2001 S Woodruff Ave
Ste 4
Idaho Falls, ID 83404
Phone (208) 419-3271

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D2287657Precision Family Medicine & Aesthetics LLC2001 S Woodruff Ave Ste 4, Idaho Falls, ID 83404Certificate of waiverAug 15, 2027

NPI Registry JSON

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

{
    "created_epoch": "1659830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1760119986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 11",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 S WOODRUFF AVE STE 11",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046372",
            "telephone_number": "208-757-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRECISION FAMILY MEDICINE & AESTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-07",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "RADFORD",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-419-3271",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.