Individual provider Active NPI

John Benjamin Traul, M.D.

  • Anesthesiology Physician
  • Pocatello, ID
National Provider Identifier
1790743490
Registry record updated Aug 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
M-7587 Issued in ID
Practice address
333 N 18TH Ave Ste a
Pocatello, ID 83201-3358
Phone
(208) 232-7760
Fax
(208) 232-1950
NPI assigned
May 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X M-7587 ID Primary

Addresses

Primary practice location

333 N 18TH Ave Ste a
Pocatello, ID 83201-3358

Mailing address

PO Box 4107
Pocatello, ID 83205-4107
Phone (208) 232-7760

Other identifiers 1

IdentifierTypeStateIssuer
805209000MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141114001125 OR Practitioner - Anesthesiology 4981769643 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical College of Ohio, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Anesthesia Physicians PCGroup PAC ID 3274420138, 93 clinicians

Practice addresses (Care Compare)

3333 Riverbend Dr
Springfield, OR 97477-8800
Phone (541) 222-2300

Hospital & facility affiliations

  • Sacred Heart Medical Center - Riverbend Hospital, Springfield, OR, CCN 380102

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Anesthesia Physicians PC Anesthesiology CurrentSince Jan 23, 2023 Accepting new patients
Roseburg Anesthesiology Specialists Anesthesiology CurrentSince Oct 1, 2014 Accepting new patients

Locations

2801 NW Mercy Dr
Roseburg, OR 97471
Phone (541) 222-2700

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

3333 Riverbend Dr
Springfield, OR 97477
Phone (541) 222-3154

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1146528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375920000000",
    "number": "1790743490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4107",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054107",
            "telephone_number": "208-232-7760",
            "fax_number": "208-232-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 N 18TH AVE STE A",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013358",
            "telephone_number": "208-232-7760",
            "fax_number": "208-232-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAUL",
        "first_name": "JOHN",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-02",
        "last_updated": "2013-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ID",
            "license": "M-7587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805209000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.