NPIMap

Organization Active NPI

Rock Creek Anesthesia Services PLLC

  • Anesthesiology Physician
  • Twin Falls, ID
National Provider Identifier
1790284198
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ROCK CREEK ANESTHESIA SERVICES PLLC
Practice address
115 Falls Ave W
Twin Falls, ID 83301-3115
Phone
(208) 733-1662
Fax
(208) 733-9463
NPI assigned
Feb 12, 2018
Last updated
Aug 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Thad Hollist, CRNANPI 1639521024
Title
Managing Member
Phone
(208) 734-3356

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
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

115 Falls Ave W
Twin Falls, ID 83301-3115

Mailing address

1358 Fillmore St
Twin Falls, ID 83301-3392
Phone (208) 734-3356

Other practice location 1

1502 Locust St N
Twin Falls, ID 83301-4162
Phone (208) 734-3356

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180406000956 ID Part B Supplier - Clinic/Group Practice 1355604299 Receives reassigned benefits from 14 practitioners
Practice locations: Chubbuck, ID; Twin Falls, ID

National Provider Directory

National Provider Directory

Locations

5640 Harvest Springs Blvd
Pocatello, ID 83202
Phone (208) 217-9224

1502 Locust St N
Twin Falls, ID 83301

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1518393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1790284198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1358 FILLMORE ST",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013392",
            "telephone_number": "208-734-3356",
            "fax_number": "208-733-9463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 FALLS AVE W",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013115",
            "telephone_number": "208-733-1662",
            "fax_number": "208-733-9463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1502 Locust St N",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833014162",
            "country_code": "US",
            "telephone_number": "208-734-3356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ROCK CREEK ANESTHESIA SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-12",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "HOLLIST",
        "authorized_official_first_name": "THAD",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "208-734-3356",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "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 Aug 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.