Falls Medical Aesthetics, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FALLS MEDICAL AESTHETICS, PLLC

Doing business as

Idaho Skin Center

Practice address

3760 Washington Pkwy
Idaho Falls, ID 83404-7593

Phone

(208) 881-5779

NPI assigned

Oct 8, 2019

Last updated

Nov 29, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Anthony Rieth

Title

Managing Member

Phone

(208) 716-4741

Specialties & licenses 1

Addresses

Other names 1

• Idaho Skin Center Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIGACD

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kierstin Nebeker, DNP

  • Family Nurse Practitioner
  • Idaho Falls, ID
  • NPI 1760720064
  Medicare reassignment Care Compare group NPD
• Brandon Leon Larsen, PA-C

  • Medical Physician Assistant
  • Idaho Falls, ID
  • NPI 1215523337
  Medicare reassignment Care Compare group NPD (past)
• Tai Banta

  • Physician Assistant
  • Idaho Falls, ID
  • NPI 1467185843
  Medicare reassignment
• Cole Landon, PA-C

  • Trauma Surgery Physician
  • Bakersfield, CA
  • NPI 1184286957

  ID

  Medicare reassignment

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606608000000",
    "number": "1831730118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047593",
            "telephone_number": "208-881-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047593",
            "telephone_number": "208-881-5779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 S. Leadville Ave.",
            "address_purpose": "LOCATION",
            "city": "Ketchum",
            "state": "ID",
            "postal_code": "83340",
            "country_code": "US",
            "telephone_number": "208-881-5779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FALLS MEDICAL AESTHETICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "last_updated": "2020-11-29",
        "certification_date": "2020-11-29",
        "status": "A",
        "authorized_official_last_name": "RIETH",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "208-716-4741"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Skin Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eyecare Center Idaho Falls LLC
• Eyedaho Optometric LLC
• Eyedaho Optometric LLC
• Eyemart Express LLC
• Eyemart Express LTD
• Family Care Center
• Family Care Center
• Family Care Center
• Family Care Center
• Family Care Center

• Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.