Individual provider Active NPI

Marcus D Neff, DDS

  • General Practice Dentistry
  • Pocatello, ID
National Provider Identifier
1811907744
Registry record updated Mar 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3710 Issued in ID
Practice address
1000 N 8TH Ave
Pocatello, ID 83201-5757
Phone
(208) 232-3368
Fax
(208) 776-5016
NPI assigned
Aug 9, 2006
Last updated
Mar 10, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D3710 ID Primary

Addresses

Primary practice location

1000 N 8TH Ave
Pocatello, ID 83201-5757

Mailing address

1000 N 8TH Ave
Pocatello, ID 83201-5757
Phone (208) 232-3368

Other identifiers 2

IdentifierTypeStateIssuer
1952316341OtherIDNPI FOR BUSINESS
806687200MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151208001861 ID Order and Referring Only - DentistPractitioner - Dentist 8820398209

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D3710IDMDGeneral Practice Dentistry

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Health West PocatelloPocatello, ID, CCN 131819 Federally qualified health center Corporate Director
W-2 Managing Employee
Jun 30, 2014
Jun 30, 2014
Health West LavaLava Hot Springs, ID, CCN 131801 Federally qualified health center Corporate Director
W-2 Managing Employee
Jun 30, 2014
Jun 30, 2014
Health West American FallsAmerican Falls, ID, CCN 131802 Federally qualified health center Corporate Director
W-2 Managing Employee
Jun 30, 2014
Jun 30, 2014
Health West Family Medicine ClinicPocatello, ID, CCN 131846 Federally qualified health center Corporate Director
W-2 Managing Employee
Jun 30, 2014
Jun 30, 2014
Health West IncChubbuck, ID, CCN 131852 Federally qualified health center Corporate Director
W-2 Managing Employee
Jun 30, 2014
Jun 30, 2014

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489104000000",
    "number": "1811907744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N 8TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015757",
            "telephone_number": "208-232-3368",
            "fax_number": "208-776-5016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 N 8TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015757",
            "telephone_number": "208-232-3368",
            "fax_number": "208-776-5016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEFF",
        "first_name": "MARCUS",
        "middle_name": "D",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2017-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3710",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR BUSINESS",
            "identifier": "1952316341",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806687200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.