| Community Care West Side LLC | |
|
765 S Utah Ave Idaho Falls ID 83402-5093 | |
| (208) 525-2600 | |
| (208) 525-2611 |
| Full Name | Community Care West Side LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 765 S Utah Ave, Idaho Falls, Idaho |
| Authorized Official Name and Position | Heather Mcvey (OFFICE MANAGER) |
| Authorized Official Contact | 2085252600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Community Care West Side LLC 765 S Utah Ave Idaho Falls ID 83402-5093 Ph: (208) 525-2600 | Community Care West Side LLC 765 S Utah Ave Idaho Falls ID 83402-5093 Ph: (208) 525-2600 |
| NPI Number | 1295009785 |
|---|---|
| Provider Enumeration Date | 02/29/2012 |
| Last Update Date | 04/05/2017 |
| Medicare PECOS PAC ID | 3678738218 |
|---|---|
| Medicare Enrollment ID | O20120703000554 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295009785 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Bryan D Hammar |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1841219987 PECOS PAC ID: 8022007988 Enrollment ID: I20040507000248 |
| Provider Name | Kristi L Grigg |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1831118801 PECOS PAC ID: 0345212676 Enrollment ID: I20040809000300 |
| Provider Name | James L Blaine |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1801963459 PECOS PAC ID: 1254303498 Enrollment ID: I20040809001269 |
| Provider Name | Derek R Campbell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306865464 PECOS PAC ID: 2466359799 Enrollment ID: I20041020000902 |
| Provider Name | Kristine P Kingery |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1679517155 PECOS PAC ID: 2668491465 Enrollment ID: I20051121000892 |
| Provider Name | Joshua E Hansen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588948087 PECOS PAC ID: 7012181530 Enrollment ID: I20111118000565 |
| Provider Name | Trevor R Bartlett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639442973 PECOS PAC ID: 1456515840 Enrollment ID: I20120615000028 |
| Provider Name | Cristy Waters |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1760753081 PECOS PAC ID: 0042472227 Enrollment ID: I20140820001413 |
| Provider Name | Scott Bradley Schaffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720410012 PECOS PAC ID: 2961620620 Enrollment ID: I20140821002846 |
| Provider Name | Bryce Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023417037 PECOS PAC ID: 4880919190 Enrollment ID: I20150209001124 |
| Provider Name | Jamie L Gudmunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669853719 PECOS PAC ID: 3971816448 Enrollment ID: I20150714000351 |
| Provider Name | Justin S Nielsen |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1235443193 PECOS PAC ID: 1456543883 Enrollment ID: I20150730012740 |
| Provider Name | Justus F Lambson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922262542 PECOS PAC ID: 9133439573 Enrollment ID: I20151113002211 |
| Provider Name | Karma R Youngstrom |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1093186280 PECOS PAC ID: 4284934175 Enrollment ID: I20151125000914 |
| Provider Name | Stanford B Gammon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1477992592 PECOS PAC ID: 4981846011 Enrollment ID: I20160301001009 |
| Provider Name | Amber Rae Hays |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1922458538 PECOS PAC ID: 9335434265 Enrollment ID: I20160817000755 |
| Provider Name | Janna K Baker |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1376842138 PECOS PAC ID: 5395923924 Enrollment ID: I20160908000859 |
| Provider Name | Thomas D Fife |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1689022519 PECOS PAC ID: 2961780887 Enrollment ID: I20161027002323 |
| Provider Name | Samantha Lange |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1346792033 PECOS PAC ID: 9436439304 Enrollment ID: I20161212000490 |
| Provider Name | Matthew F Ivie |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1003325937 PECOS PAC ID: 6608134218 Enrollment ID: I20180102002270 |
| Provider Name | Jeremy Chad Rindlisbacher |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063851889 PECOS PAC ID: 5698915593 Enrollment ID: I20180126001255 |
| Provider Name | Devn a Frandsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730316043 PECOS PAC ID: 9032344064 Enrollment ID: I20180504001917 |
| Provider Name | Zachary M Buck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871023135 PECOS PAC ID: 3577832302 Enrollment ID: I20190131002816 |
| Provider Name | David Winchester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730655283 PECOS PAC ID: 2466790183 Enrollment ID: I20190205001008 |
| Provider Name | Todd I Cranor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1477021020 PECOS PAC ID: 6800136110 Enrollment ID: I20190325001324 |
| Provider Name | Hailey a Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487125969 PECOS PAC ID: 8921348129 Enrollment ID: I20190326002408 |
| Provider Name | Magno C Santos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881935104 PECOS PAC ID: 0143454173 Enrollment ID: I20190604001208 |
| Provider Name | Tina Scoggins |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1689037129 PECOS PAC ID: 3375882988 Enrollment ID: I20191030002281 |
| Provider Name | Benjamin J Atwood |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1821645870 PECOS PAC ID: 7911339023 Enrollment ID: I20191111002802 |
| Provider Name | Rebekah M Lucero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285295634 PECOS PAC ID: 3779915582 Enrollment ID: I20191118000040 |
| Provider Name | Hilary Zitlau |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1740816511 PECOS PAC ID: 8123449907 Enrollment ID: I20200603000994 |
| Provider Name | Chance D Christensen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841784535 PECOS PAC ID: 6305194770 Enrollment ID: I20200612000768 |
| Provider Name | Benjamin Leishman |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1063862977 PECOS PAC ID: 3375839517 Enrollment ID: I20200707002607 |
| Provider Name | Jonathan L Wilford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013203314 PECOS PAC ID: 6800035742 Enrollment ID: I20200929001916 |
| Provider Name | Brandon Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255947255 PECOS PAC ID: 0143633297 Enrollment ID: I20210108001296 |
| Provider Name | Brianna J Krainchich |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1164018123 PECOS PAC ID: 5991119760 Enrollment ID: I20210208000809 |
| Provider Name | Tate Coltan Staker |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184253585 PECOS PAC ID: 1456767508 Enrollment ID: I20210315002575 |
| Provider Name | Shad Crapo |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912476649 PECOS PAC ID: 2163764960 Enrollment ID: I20210323000727 |
| Provider Name | Jordan Forbush |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821680166 PECOS PAC ID: 5496154684 Enrollment ID: I20210519003174 |
| Provider Name | Sam Jensen Wright |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1457023244 PECOS PAC ID: 4486042405 Enrollment ID: I20211025002019 |
| Provider Name | Kirk Bigley |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1265887772 PECOS PAC ID: 2668765751 Enrollment ID: I20220208001740 |
| Provider Name | Tim R Schuijt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801550553 PECOS PAC ID: 7113312620 Enrollment ID: I20220321000782 |
| Provider Name | Monique Catron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952066177 PECOS PAC ID: 9537555412 Enrollment ID: I20220331002409 |
| Provider Name | Stephanie Ann Orr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285392720 PECOS PAC ID: 6002046901 Enrollment ID: I20220414002130 |
| Provider Name | Benjamin Jacob Johnson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1982356366 PECOS PAC ID: 2961899851 Enrollment ID: I20220422002186 |
| Provider Name | Jenni Lee Borg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356096614 PECOS PAC ID: 8820475031 Enrollment ID: I20220509002011 |
| Provider Name | Cole Landon |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1184286957 PECOS PAC ID: 8527492594 Enrollment ID: I20220511001918 |
| Provider Name | Alison Noel Thompson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437745528 PECOS PAC ID: 0547647497 Enrollment ID: I20220513001765 |
| Provider Name | Colter Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215670013 PECOS PAC ID: 8224419692 Enrollment ID: I20220715001758 |
| Provider Name | Jaden Juergens |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1538810577 PECOS PAC ID: 9133597644 Enrollment ID: I20221114003184 |
| Provider Name | Wesley Kenyon Butler |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1881317329 PECOS PAC ID: 6709257926 Enrollment ID: I20230126002368 |
| Provider Name | Kelsey Despain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700594967 PECOS PAC ID: 5193198059 Enrollment ID: I20230224001007 |
| Provider Name | Devri Burnell |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1700512795 PECOS PAC ID: 5799150736 Enrollment ID: I20230405001838 |
| Provider Name | Travis Gilbert |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1770093619 PECOS PAC ID: 1153682232 Enrollment ID: I20230428002062 |
| Provider Name | Nathan Thompson Burke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558074955 PECOS PAC ID: 8325405723 Enrollment ID: I20230530002573 |
| Provider Name | Leathie Bickmore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609640333 PECOS PAC ID: 9032554175 Enrollment ID: I20240228004836 |
| Provider Name | Christopher Leif Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023886397 PECOS PAC ID: 9032555057 Enrollment ID: I20240313001878 |
| Provider Name | Melisa Stacey Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043074537 PECOS PAC ID: 8325585607 Enrollment ID: I20240805001214 |
| Provider Name | Anna Gelok |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063772614 PECOS PAC ID: 2668622499 Enrollment ID: I20241120000458 |
| Provider Name | Chloe Olivia Seegmiller |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1063102713 PECOS PAC ID: 8224565916 Enrollment ID: I20241219000085 |
| Provider Name | Jenny M Ball |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306674197 PECOS PAC ID: 3577090653 Enrollment ID: I20241231003222 |
| Provider Name | Kyle Jacob Murchie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881417244 PECOS PAC ID: 0749718187 Enrollment ID: I20250113001798 |
| Provider Name | Karen Del Rosario Silva Hardin |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1730816737 PECOS PAC ID: 3476073024 Enrollment ID: I20250226000424 |
| Provider Name | Katelyn Rose Willis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003613316 PECOS PAC ID: 8820515000 Enrollment ID: I20250512000459 |
| Provider Name | Elaina Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972496834 PECOS PAC ID: 9436663838 Enrollment ID: I20250708003595 |
| Provider Name | Austin Stewart Jones |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1568260495 PECOS PAC ID: 6305334327 Enrollment ID: I20251022001350 |
| Provider Name | Makaylie Sorensen Crowther |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104700046 PECOS PAC ID: 0143719211 Enrollment ID: I20251029001867 |
| Provider Name | Kyle Gebs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225904907 PECOS PAC ID: 1759873045 Enrollment ID: I20251124003562 |
| Provider Name | Nikole Kirby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285502138 PECOS PAC ID: 9436625381 Enrollment ID: I20260417000946 |
| Provider Name | Joshua Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194693689 PECOS PAC ID: 6103399985 Enrollment ID: I20260623004226 |
Shane G Machen, DO Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1995 E 17th St Ste A, Idaho Falls, ID 83404 Phone: 208-522-7666 Fax: 208-524-2821 |
Physician Skin Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 730 S Woodruff Ave, Idaho Falls, ID 83401 Phone: 208-542-9111 |
Family First Medical Center, PLLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3614 Washington Pkwy, Idaho Falls, ID 83404 Phone: 208-552-7700 Fax: 208-552-1783 |
Imed Hrs Idaho Falls Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3100 Channing Way, Idaho Falls, ID 83404 Phone: 801-507-3500 |
Neville Spinal Balance PLLC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2145 West Broadway Street, Idaho Falls, ID 83402 Phone: 208-522-3130 |
R.K. Arbon, M.D., P.A. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2860 Channing Way, Suite 116, Idaho Falls, ID 83404 Phone: 208-529-0575 Fax: 208-528-0223 |