Active NPI
Ray William Hanson, MD
- Surgery Physician
- Idaho Falls, ID
National Provider Identifier
1861440513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- M-9006
- Practice address
- 2325 Coronado St
Idaho Falls, ID 83404-7407 - Phone
- (208) 557-2700
- NPI assigned
- May 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | M-9006 | ID | Primary |
Addresses
Primary practice location
2325 Coronado St
Idaho Falls, ID 83404-7407
Mailing address
PO Box 3568
Idaho Falls, ID 83403-3568
Phone (208) 552-8573
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B4851 | Other | ID | BLUE CROSS OLD |
| HB399 | Other | ID | BLUE CROSS |
| 313058 | Other | ID | ALTIUS |
| 807127000 | 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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401753600000",
"number": "1861440513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3568",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834033568",
"telephone_number": "208-552-8573",
"fax_number": "208-523-2025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2325 CORONADO ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047407",
"telephone_number": "208-557-2700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSON",
"first_name": "RAY",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2014-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ID",
"license": "M-9006",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OLD",
"identifier": "B4851",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "HB399",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS",
"identifier": "313058",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807127000",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.