Victor Kyle Mumford

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

1969 Issued in NE

Practice address

9040 Fitzsimmons Dr
Joint Base Lewis McChord, WA 98431-1000

Phone

(253) 968-0208

NPI assigned

Mar 4, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Internal Medicine

Education

Lake Erie College of Osteopathic Medicine, Erie, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Utah Regional Hospitalists LLCGroup PAC ID 4789807165, 119 clinicians

Santibanez Pac IdahoGroup PAC ID 2961846209, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018
• Teton Valley Hospital Hospital, Driggs, ID, CCN 131313
• Eastern Idaho Regional Medical Center Inpatient rehabilitation facility, Idaho Falls, ID, CCN 13T018
• Eagle Rock Health and Rehabilitation of Cascadia Nursing home, Idaho Falls, ID, CCN 135092

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Santibanez Pac Idaho

  • Geriatric Medicine (Internal Medicine) Physician
  • Idaho Falls, ID
  • NPI 1346015948
  Medicare reassignment Care Compare group NPD
• Utah Regional Hospitalists LLC

  dba Utah Regional Hospitalists

  • Hospitalist Physician
  • Idaho Falls, ID
  • NPI 1740715507
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Eastern Idaho Health Services Inc

  dba Eastern Idaho Regional Medical Center

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1225082209
  Care Compare affiliation
• Eastern Idaho Health Services, Inc.

  dba Eastern Idaho Regional Medical Center

  • Rehabilitation Hospital Unit
  • Idaho Falls, ID
  • NPI 1952355935

  Inpatient rehabilitation facility

  Care Compare affiliation
• Idaho Falls North of Cascadia, LLC

  • Skilled Nursing Facility
  • Idaho Falls, ID
  • NPI 1972220473

  Nursing home

  Care Compare affiliation
• Teton Valley Health Care Inc

  dba Teton Valley Health Care

  • Critical Access Hospital
  • Driggs, ID
  • NPI 1477809622
  Care Compare affiliation

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

{
    "created_epoch": "1488585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596412800000",
    "number": "1881134211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 FITZSIMMONS DR",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984311000",
            "telephone_number": "253-968-0208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9040 FITZSIMMONS DR",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984311000",
            "telephone_number": "253-968-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUMFORD",
        "first_name": "VICTOR",
        "middle_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-04",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NE",
            "license": "1969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emani Georgette Morgan
• Ronald Richardson Morris, MD
• Douglas Ryan Morte, M.D.
• Cesserie Samantha Moyer, PA-C
• Daniel Luke Mudd, DVM
• Jaysen J Muniz Sanchez, COTA/L
• Jessica Lynn Nelson, MD
• Jon Neumann, PT
• Taylor Johnson Newman
• Cathy Nguyen

• General Practice Physician in Joint Base Lewis McChord, WA
• Providers in Joint Base Lewis McChord, WA by specialty
• General Practice Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; 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.