Altitude Sport & Spine PLLC

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

ALTITUDE SPORT & SPINE PLLC

Practice address

1582 Elk Creek Dr
Idaho Falls, ID 83404-8322

Phone

(208) 213-5256

NPI assigned

Jan 13, 2026

Organization subpart

No

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

Authorized official

Name

Joshua Sirucek, DO

Title

Owner

Phone

(208) 213-5256

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Benjamin Leishman, D.O.

  • Family Medicine Physician
  • Idaho Falls, ID
  • NPI 1063862977

  ID

  Medicare reassignment Care Compare group
• Josh Sirucek, D.O.

  • Family Medicine Physician
  • Idaho Falls, ID
  • NPI 1487066643

  ID

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1768262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768262400000",
    "number": "1992663595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1582 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-213-5256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1582 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-213-5256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALTITUDE SPORT & SPINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-13",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-12",
        "status": "A",
        "authorized_official_last_name": "SIRUCEK",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-213-5256",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alpine Anesthesia LLC
• Alpine Chiropractic Health Center PA
• Alpine Counseling, PLLC
• Alpine Ear, Nose & Throat, P.C
• Alpine Home Medical Equipment LLC
• Angelica Grace Alvarez Titus
• Anita R Alvarez, RN,BSN,PCCN,SANE-A
• Lorena Alvarez, LMSW
• Braden Mitchel Amann, DO
• Kyle Samuel Amburgey

• All providers in Idaho Falls, ID
• Sports Medicine (Family Medicine) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.