Bryan Wayne Anderson, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

151 N 3Rd Ave Ste 330
Pocatello, ID 83201-6369

Phone

(208) 242-3771

NPI assigned

Sep 8, 2021

Last updated

Sep 8, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

East Idaho Mental Health LLCGroup PAC ID 1850830837, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• East Idaho Mental Health LLC

  • Counselor
  • Rexburg, ID
  • NPI 1629825526
  Medicare reassignment Care Compare group NPD
• Destin Thayne Bep Inc

  • Family Medicine Physician
  • Rexburg, ID
  • NPI 1790244424
  NPD
• Gateway Counseling Incorporated

  • Community/Behavioral Health Agency
  • Pocatello, ID
  • NPI 1528366424
  NPD

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

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1861161432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N 3RD AVE STE 330",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016369",
            "telephone_number": "208-242-3771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 N 3RD AVE STE 330",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832016369",
            "telephone_number": "208-242-3771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "BRYAN",
        "middle_name": "WAYNE",
        "credential": "NCC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-08",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas Ken Andersen, DO
• Joseph Soren Andersen
• Matthew Colt Andersen, LPC
• Angela Babb Anderson, PT
• Brice Anderson, MSAT, LAT, ATC, CSCS
• Danielle Lynn Anderson, RN
• Garret Anderson
• Gary Steven Anderson
• Isabella Raquel Anderson, LPC
• Jordan Scott Anderson, DPT

• Mental Health Counselor in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Mental Health Counselor in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.