Bryce David Wylie, PA-C
Individual provider Active NPI Physician Assistant · Saint Anthony, ID
NPI 1811043862 · NPPES record last updated Mar 11, 2024
Key facts
- NPI
- 1811043862
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA-1013 (ID)
- Practice address
- 335 E Main St Ste 1
Saint Anthony, ID 83445-1546 - Phone
- (208) 356-4900
- Fax
- (208) 624-4116
- NPI assigned
- Jan 25, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Upper Valley Community Health Services Inc
Practice addresses (Care Compare)
335 E Main St
Saint Anthony, ID 83445-1546
Phone (208) 356-4900
Hospital & facility affiliations
- Eastern Idaho Regional Medical Center
- Mountain View Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121114000659 | ID | Practitioner - Physician Assistant | 1951470681 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 441 | WY | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upper Valley Community Health Services Inc | Current |
Accepting new patients | |
| Upper Valley Community Health Services, Inc. | Current |
Accepting new patients | |
| Upper Valley Community Health Services Inc | Past | Accepting new patients | |
| Upper Valley Community Health Services Inc | Past | Accepting new patients | |
| Upper Valley Community Health Services Inc | Past | Accepting new patients |
Locations
3729 Woodking Dr
#1
Idaho Falls, ID 83404
Phone (208) 522-3404
72 S 1st E
Ste 101
Rexburg, ID 83440
335 E Main St
Ste 1
Saint Anthony, ID 83445
335 E Main St
Ste 3
Saint Anthony, ID 83445
Phone (208) 624-4100
20 N 3rd E
Saint Anthony, ID 83445
Phone (208) 624-4100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA-1013 | ID | Yes |
Addresses
Primary practice location
335 E Main St Ste 1
Saint Anthony, ID 83445-1546
Mailing address
PO Box 18
Saint Anthony, ID 83445-0018
Phone (208) 356-4900
Other practice location 1
72 S 1st E Ste 101
Rexburg, ID 83440-1965
Phone (208) 356-4900
Other practice location 2
3729 Woodking Dr Ste 1
Idaho Falls, ID 83404-4720
Phone (208) 356-4900
Other providers in Saint Anthony, ID
- Jenny Rickell Willmore
- Ryan G Willmore
- Beth Winegar
- Tara Lyanne Wood
- Bryce S Woodfield
- Brett W Zundel
All providers in Saint Anthony, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.