Unknown Individual – Medical Physician Assistant, NPI 1265441547
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
1110, Call Creek Drive, Pocatello, Bannock County, Idaho, 83201, United States
STE 7
POCATELLO, ID 832013072
Phone: (208) 233-2032
Fax: (208) 233-2175
Type: Mailing
Yellowstone Avenue, Pocatello, Bannock County, Idaho, 83201, United States
STE E
POCATELLO, ID 832014528
Phone: (208) 232-0021
Fax: (208) 232-0031
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 4 Open Payments records for all available years, with a total value of $127.
Total Amount is formed as General ($127) + Research ($0) + Ownership ($0) = $127.
Last reported payment date: 2023-09-13 • Largest payer in this snapshot: ABBVIE INC. ($89).
Total Amount
$127
General + Research + Ownership
Payments
4
Total payment records
General Amount
$127
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-09-13
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $89 |
| Astellas Pharma US Inc | $24 |
| Novo Nordisk Inc | $14 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 23 | 23 | $0 |
| 36415 | Insertion of needle into vein for collection of blood sample | 17 | 15 | $0 |
Insurance plans in this area (ZIP 83201)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | ID | |
| Physician Assistant | ID | |
| Nurse Practitioner | ID | |
| Nurse Practitioner | ID | |
| Physician Assistant | ID | |
| Nurse Practitioner | ID | |
| Nurse Practitioner | ID | |
| Physician Assistant | ID | |
| Nurse Practitioner | ID | |
| Nurse Practitioner | ID |
Reviews
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