Active NPI
Floyd Joseph Fantelli, MD
- Anatomic Pathology & Clinical Pathology Physician
- Idaho Falls, ID
National Provider Identifier
1831167113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- M4216
- Practice address
- 3100 Channing Way
Idaho Falls, ID 83404-7533 - Phone
- (208) 529-6050
- Fax
- (208) 529-7085
- NPI assigned
- Mar 10, 2006
- Last updated
- Jan 18, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | M4216 | ID | Primary |
Addresses
Primary practice location
3100 Channing Way
Idaho Falls, ID 83404-7533
Mailing address
1740 E 17TH St
Ste D
Idaho Falls, ID 83404-6375
Phone (208) 529-9779
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 42168 | Other | ID | BLUE CROSS OF ID |
| 000010004040 | Other | ID | REGENCE BLUE SHIELD ID |
| 003697200 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4216 | ID | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263772800000",
"number": "1831167113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1740 E 17TH ST",
"address_2": "STE D",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834046375",
"telephone_number": "208-529-9779",
"fax_number": "208-542-2756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 CHANNING WAY",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047533",
"telephone_number": "208-529-6050",
"fax_number": "208-529-7085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANTELLI",
"first_name": "FLOYD",
"middle_name": "JOSEPH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2010-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "ID",
"license": "M4216",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF ID",
"identifier": "42168",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD ID",
"identifier": "000010004040",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003697200",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
- Family Medicine Hub PLLC (Blair Family Medicine)
- Family Recovery Center Foundation
- Family Resource Centers of America
- Family Resource Centers of America, Inc
- Famliy Dental Health Center (Burtenshaw Craig A & G Staley GPS)
- Darla Jane Faraday, PH.D.
- Rebecca Lynn Farmer, MA
- Preston Scott Farnsworth, RN
- Wesley Robert Farrens, LMSW
- Katrina Davis Favero, CRNA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.