NPIMap

Individual provider Active NPI

Shane Gary Machen, D.O.

  • Family Medicine Physician
  • Idaho Falls, ID
National Provider Identifier
1932330370
Registry record updated Dec 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-0611 Issued in ID
Practice address
1995 E 17TH St
Idaho Falls, ID 83404-6493
Phone
(208) 522-7666
Fax
(208) 524-2821
NPI assigned
Aug 3, 2009
Last updated
Dec 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-0611 ID Primary

Addresses

Primary practice location

1995 E 17TH St
Idaho Falls, ID 83404-6493

Mailing address

1995 E 17TH St
Idaho Falls, ID 83404-6493
Phone (208) 522-7666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110831000471 ID Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 0244410462 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Osteopathic Manipulative Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2305 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-1764

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

2330 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

2351 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-7310

2353 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-4823

2375 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

3385 Potomac Way
Idaho Falls, ID 83404-4978
Phone (208) 522-7246

3500 Potomac Way
Suite 100
Idaho Falls, ID 83404-4977
Phone (208) 522-7666

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Hospital LLC CurrentSince Sep 8, 2019 Accepting new patients
Rocco P. Cifrese, MD and Sara a. Cifrese, MD PA Family Medicine Current Accepting new patients
Eirmc Hospitalist Services LLC Past Accepting new patients

Locations

1995 E 17th St
Idaho Falls, ID 83404
Phone (208) 403-2107

1995 E 17th St
Ste A
Idaho Falls, ID 83404
Phone (208) 522-7666

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

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

3500 Potomac Way
#100
Idaho Falls, ID 83404
Phone (208) 522-7666

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1249257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1932330370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1995 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046493",
            "telephone_number": "208-522-7666",
            "fax_number": "208-524-2821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1995 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046493",
            "telephone_number": "208-522-7666",
            "fax_number": "208-524-2821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACHEN",
        "first_name": "SHANE",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-03",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-0611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.