Idaho Surgicenter Inc

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

IDAHO SURGICENTER INC

Doing business as

Idaho SurgiCenter South

Practice address

1157 Call Place
Pocatello, ID 83201

Phone

(208) 238-6337

Fax

(208) 776-5510

NPI assigned

May 22, 2006

Last updated

Jan 31, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sean Barnard

Title

Administrator

Phone

(208) 852-6242

Specialties & licenses 5

Addresses

Other identifiers 5

Other names 1

• Idaho SurgiCenter South Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Listed as

Idaho Surgicenter IncCCN 13C0001031

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David K Croshaw, DPM

  • Podiatrist
  • Pocatello, ID
  • NPI 1518949684
  NPD (past)
• Brandon D Wilde, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Pocatello, ID
  • NPI 1407169865
  NPD (past)

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1992759930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2067",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832062067",
            "telephone_number": "208-238-6337",
            "fax_number": "208-776-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1157 CALL PLACE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83201",
            "telephone_number": "208-238-6337",
            "fax_number": "208-776-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO SURGICENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "BARNARD",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-852-6242",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "ID",
            "license": "P166",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "ID",
            "license": "P92",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "ID",
            "license": "P153",
            "primary": false
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010027108",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805730900",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00091636",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "03913",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807288200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho SurgiCenter South",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho SurgiCenter South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Idaho State University (ISU Dental Hygiene Clinic)
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• Idaho State University Health Center
• Idaho State University, Psychology Clinic
• Idaho Transportation Company, Inc
• Ihc Health Services Inc (IMED HRS Idaho)
• Imhealth LLC
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• Independent Living Specialists, LLC

• Ambulatory Surgical Clinic/Center in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Ambulatory Surgical Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.