NPIMap

Individual provider Active NPI

Clark Hunter Allen, M.D.

  • Neurological Surgery Physician
  • Idaho Falls, ID
National Provider Identifier
1780679126
Registry record updated Dec 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
M8027 Issued in ID
Practice address
3345 Potomac Way
Idaho Falls, ID 83404
Phone
(208) 552-6210
Fax
(208) 552-2027
NPI assigned
Sep 13, 2005
Last updated
Dec 21, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X M8027 ID Primary

Addresses

Primary practice location

3345 Potomac Way
Idaho Falls, ID 83404

Mailing address

3345 Potomac Way
Idaho Falls, ID 83404
Phone (208) 552-6210

Other identifiers 1

IdentifierTypeStateIssuer
805808300MedicaidID

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
I20080822000321 ID Practitioner - Neurosurgery 6901970912 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Virginia Commonwealth University, School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
BMH IncGroup PAC ID 8426149758, shared by 7 NPIs, 137 clinicians
Bingham Memorial HospitalGroup PAC ID 8426955014, 68 clinicians

Practice addresses (Care Compare)

315 W Idaho St
Blackfoot, ID 83221-1711
Phone (208) 782-3990

98 Poplar St
Blackfoot, ID 83221-1758
Phone (208) 785-4100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion162
Laminectomy or laminotomy (partial removal of spine bones)44

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M8027IDMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
BMH, Inc. Current Accepting new patients
BMH, Inc. CurrentSince Oct 1, 2020 Accepting new patients
BMH Inc CurrentSince Oct 1, 2020 Accepting new patients
BMH, Inc CurrentSince Oct 1, 2020 Accepting new patients
Dr. Farrell, LLC Past Accepting new patients
Intermountain Neurosurgery, P.a. Neurological Surgery Past Accepting new patients

Locations

315 W Idaho St
Blackfoot, ID 83221
Phone (208) 782-3990

98 Poplar St
Blackfoot, ID 83221
Phone (208) 782-3763

3302 Valencia Dr
Ste 201
Idaho Falls, ID 83404
Phone (208) 524-9400

285 Vista Dr
Pocatello, ID 83201
Phone (208) 233-8344

285 Vista Dr
Ste D
Pocatello, ID 83201
Phone (208) 232-6060

Interoperability endpoints

  • Direct secure messaging: clarkallen@bmh.medalliesdirect.net

Organizations & group practices 7

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 5

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": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450656000000",
    "number": "1780679126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 POTOMAC WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-552-6210",
            "fax_number": "208-552-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 POTOMAC WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-552-6210",
            "fax_number": "208-552-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "CLARK",
        "middle_name": "HUNTER",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-13",
        "last_updated": "2015-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "ID",
            "license": "M8027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805808300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.