NPIMap

Individual provider Active NPI

Jason Ryan Greenhalgh, M.D.

  • Urology Physician
  • Twin Falls, ID
National Provider Identifier
1952478703
Registry record updated Dec 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
M-11276 Issued in ID
Practice address
775 Pole Line Rd W
Suite 301
Twin Falls, ID 83301-5814
Phone
(208) 814-8700
Fax
(208) 933-4914
NPI assigned
Nov 29, 2006
Last updated
Dec 29, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 29, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X R-7693 IA
Urology Physician 208800000X M-11276 ID Primary

Addresses

Primary practice location

775 Pole Line Rd W
Suite 301
Twin Falls, ID 83301-5814

Mailing address

PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400

Other identifiers 2

IdentifierTypeStateIssuer
P00983738OtherIDMCRR
1952478703MedicaidID

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
I20110824000527 ID Practitioner - Urology 4486824711 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Magic Valley Urology PLLCGroup PAC ID 0446664247, 3 clinicians

Practice addresses (Care Compare)

2114 Village Park Ave
Suite 200
Twin Falls, ID 83301-4172
Phone (208) 733-3404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-7693IAMDUrology Physician
M-11276IDMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Lakes Anesthesia CurrentSince Jan 3, 2026 Accepting new patients
Paramount Surgical Services LLC CurrentSince Oct 1, 2024 Accepting new patients
Magic Valley Urology PLLC Urology CurrentSince Oct 12, 2020 Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

2095 Dawson Dr
Twin Falls, ID 83301
Phone (208) 733-3404

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIADCD

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 5

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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419811200000",
    "number": "1952478703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 301",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8700",
            "fax_number": "208-933-4914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENHALGH",
        "first_name": "JASON",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2014-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IA",
            "license": "R-7693",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "ID",
            "license": "M-11276",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCRR",
            "identifier": "P00983738",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952478703",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.