NPIMap

Organization Active NPI

Destin Thayne Bep Inc

  • Family Medicine Physician
  • Rexburg, ID
National Provider Identifier
1790244424
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DESTIN THAYNE BEP INC
Practice address
859 S Yellowstone Hwy Ste 3201
Rexburg, ID 83440-6200
Phone
(208) 359-2101
Fax
(208) 356-8860
NPI assigned
Mar 12, 2019
Last updated
Aug 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Authorized official

Name
Destin L Thayne
Title
Owner
Phone
(208) 359-2101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

859 S Yellowstone Hwy Ste 3201
Rexburg, ID 83440-6200

Mailing address

859 S Yellowstone Hwy Ste 3201
Rexburg, ID 83440-6200
Phone (208) 359-2101

National Provider Directory

National Provider Directory

Locations

859 S Yellowstone Hwy
Ste 3201
Rexburg, ID 83440
Phone (208) 359-2101

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1552348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628726400000",
    "number": "1790244424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "859 S YELLOWSTONE HWY STE 3201",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834406200",
            "telephone_number": "208-359-2101",
            "fax_number": "208-356-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "859 S YELLOWSTONE HWY STE 3201",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834406200",
            "telephone_number": "208-359-2101",
            "fax_number": "208-356-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTIN THAYNE BEP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-12",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A",
        "authorized_official_last_name": "THAYNE",
        "authorized_official_first_name": "DESTIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-359-2101"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.