Individual provider Active NPI

Robert T Harris, MD

  • Anesthesiology Physician
  • Idaho Falls, ID
National Provider Identifier
1912937863
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
M-8400 Issued in ID
Practice address
3100 Channing Way
Idaho Falls, ID 83404-7533
Phone
(208) 529-6111
NPI assigned
Jul 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 18791 ND
Anesthesiology Physician 207L00000X M-8400 ID Primary

Addresses

Primary practice location

3100 Channing Way
Idaho Falls, ID 83404-7533

Mailing address

255 W Michigan Ave
Jackson, MI 49201-2218
Phone (517) 787-6440

Other practice location 1

1 Burdick Expy W
Minot, ND 58701-4406
Phone (701) 857-5000

Other practice location 2

2305 37th Ave SW
Minot, ND 58701-7669
Phone (701) 857-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110218000933 ID Practitioner - Anesthesiology 0042270878 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Intermountain Anesthesia PAGroup PAC ID 5193638781, 26 clinicians

Practice addresses (Care Compare)

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone (208) 529-6111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Teton Valley Health Care Inc Current Accepting new patients
Teton Valley Health Care Inc CurrentSince Jul 1, 2015 Accepting new patients
Intermountain Anesthesia, PA Anesthesiology CurrentSince Jan 1, 2002 Accepting new patients
Teton Valley Health Care, Inc CurrentSince Jul 1, 2015 Accepting new patients

Locations

120 E Howard St
Driggs, ID 83422
Phone (208) 354-2302

3100 Channing Way
Idaho Falls, ID 83404
Phone (208) 227-2100

255 W Michigan Ave
Jackson, MI 49201

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1912937863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012218",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047533",
            "telephone_number": "208-529-6111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Burdick Expy W",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587014406",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2305 37th Ave SW",
            "address_purpose": "LOCATION",
            "city": "Minot",
            "state": "ND",
            "postal_code": "587017669",
            "country_code": "US",
            "telephone_number": "701-857-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "ROBERT",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ND",
            "license": "18791",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "ID",
            "license": "M-8400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.