Walker Spine and Sports Specialists

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

E65389 Issued in ID

Legal business name

WALKER SPINE AND SPORTS SPECIALISTS

Practice address

2319 Coronado St
Idaho Falls, ID 83404-7407

Phone

(208) 227-1200

Fax

(208) 227-1212

NPI assigned

Oct 6, 2006

Organization subpart

No

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

Authorized official

Name

Gary C Walker, MD

Title

Owner

Phone

(208) 227-1200

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/Freedom_WSSS

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

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1790872109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2319 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "208-227-1200",
            "fax_number": "208-227-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2319 CORONADO ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047407",
            "telephone_number": "208-227-1200",
            "fax_number": "208-227-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALKER SPINE AND SPORTS SPECIALISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-227-1200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "ID",
            "license": "E65389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010140195",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "204221200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8H989",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA4495",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806811100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elda Jannae Walden, M.S.
• Jessica L Waldron, LCPC
• Walgreen Co (Walgreens #11622)
• Walgreen Co (Walgreens #15973)
• Walgreen Co (Walgreens #05839)
• Betsy Gail Walker, LMSW
• Cynthia Walker, MS, CCC-SLP
• Danae Lee Walker, FNP-C
• Eric D Walker, MD
• Jedd Douglas Walker, FNP-C

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.