NPIMap

Individual provider Active NPI

Robert Kenneth Fairbanks, M.D.

  • Radiation Oncology Physician
  • Lewiston, ID
National Provider Identifier
1821084781
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
MD00037655 Issued in WA
Practice address
504 6TH St
Lewiston, ID 83501-2439
Phone
(208) 799-5600
Fax
(208) 799-5755
NPI assigned
Sep 26, 2005
Last updated
Aug 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X MD00037655 WA Primary

Addresses

Primary practice location

504 6TH St
Lewiston, ID 83501-2439

Mailing address

PO Box 239
Lewiston, ID 83501-0239
Phone (208) 799-5600

Other identifiers 8

IdentifierTypeStateIssuer
K0716OtherBLUE CROSS OF IDAHO
5034131OtherAETNA
3070FAOtherWAASURIS NW HEALTH
000010032648OtherBLUE SHIELD OF IDAHO
0144615OtherWALABOR & INDUSTRIES
805949200MedicaidID
920006292OtherRAILROAD MEDICARE
8243958MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040319001465 WA Practitioner - Radiation Oncology 5294622551 Reassigns benefits to 1 organization
I20150209001052 ID Practitioner - Radiation Oncology 5294622551 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Tulane University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Radiation PLLCGroup PAC ID 5193251486, 2 clinicians

Practice addresses (Care Compare)

504 6TH St
Lewiston, ID 83501-2439
Phone (208) 799-5600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Radiation PLLC Radiation Oncology CurrentSince Jul 30, 2024 Accepting new patients
Northwest Washington Radiation Oncology Radiation Oncology PastSince Oct 12, 2025 Accepting new patients

Locations

504 6th St
Lewiston, ID 83501
Phone (208) 799-5000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1821084781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 239",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835010239",
            "telephone_number": "208-799-5600",
            "fax_number": "208-799-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012439",
            "telephone_number": "208-799-5600",
            "fax_number": "208-799-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANKS",
        "first_name": "ROBERT",
        "middle_name": "KENNETH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-26",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "WA",
            "license": "MD00037655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "K0716",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5034131",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASURIS NW HEALTH",
            "identifier": "3070FA",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF IDAHO",
            "identifier": "000010032648",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0144615",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805949200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "920006292",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8243958",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.