NPIMap

Organization Active NPI

Rocky Mountain Physician Group LLC

  • Emergency Medicine Physician
  • Pocatello, ID
National Provider Identifier
1851808133
Registry record updated Nov 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ROCKY MOUNTAIN PHYSICIAN GROUP LLC
Practice address
777 Hospital Way
Pocatello, ID 83201-5175
Phone
(480) 421-9700
Fax
(480) 421-9700
NPI assigned
Jan 8, 2018
Last updated
Nov 5, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
ROCKY MOUNTAIN EMERGENCY PHYSICIANS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 5, 2018

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

Authorized official

Name
Daniel Dallon, MDNPI 1992967053
Title
Manager
Phone
(480) 374-7200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

777 Hospital Way
Pocatello, ID 83201-5175

Mailing address

PO Box 64568
Phoenix, AZ 85082-4568
Phone (480) 374-7200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180208002103 ID Part B Supplier - Clinic/Group Practice 7911267133 Receives reassigned benefits from 20 practitioners
Practice locations: Pocatello, ID

National Provider Directory

National Provider Directory
Part of
Rocky Mountain Emergency Physicians LLC

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541376000000",
    "number": "1851808133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 64568",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850824568",
            "telephone_number": "480-374-7200",
            "fax_number": "480-585-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "480-421-9700",
            "fax_number": "480-421-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKY MOUNTAIN PHYSICIAN GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROCKY MOUNTAIN EMERGENCY PHYSICIANS, LLC",
        "enumeration_date": "2018-01-08",
        "last_updated": "2018-11-05",
        "status": "A",
        "authorized_official_last_name": "DALLON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-374-7200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.