IDAHO SPORTS & SPINE PLLC (NPI# 1033417035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033417035 |
| Entity Type | Organization |
| Organization Name | IDAHO SPORTS & SPINE PLLC |
| Other Organization Name | CHRISTOPHER R JOHNSON DO, PLLC |
| Practice Address |
950 Hospital Way Ste A Pocatello ID 83201-2789 |
| Practice Telephone | 2084784522 |
| Practice Fax Number | 2084782935 |
| Mailing Telephone | 2084784522 |
| Mailing Fax Number | 2084782935 |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2019-11-04 |
| Authorized Official Name | STEPHEN HANSEN (OWNER) |
| Authorized Official Telephone | 2084784522 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
O-0400 | ID | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Christopher R Johnson DO, PLLC | Former Legal Business Name - Organization |
| Street Address |
950 HOSPITAL WAY STE A |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201-2789 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104928670 | Gregory M Ford | Orthopaedic Surgery | 950 Hospital Way, Ste A, Pocatello, ID 83201-2762 | 2006-09-03 |
| 1144601865 | Tanner D Mitton | Physician Assistant | 950 Hospital Way, Ste A, Pocatello, ID 83201-2762 | 2015-06-18 |
| 1477965952 | Gregory M. Ford, Md Pllc | Orthopaedic Surgery | 950 Hospital Way, Ste A, Pocatello, ID 83201-2789 | 2014-06-02 |
| 1144504663 | Advanced Healthcare Solutions LLC | Non-Pharmacy Dispensing Site | 950 Hospital Way, Pocatello, ID 83201-2789 | 2011-10-03 |
| 1104061449 | Larsen Dental Care | Dentist | 950 Hospital Way, Suite B, Pocatello, ID 83201-2789 | 2008-12-15 |
| 1285806844 | Larsen Dental Care | Dentist | 950 Hospital Way, Suite B, Pocatello, ID 83201-2789 | 2008-03-24 |
| 1770796070 | Niels Willard Larsen V | Dentist | 950 Hospital Way, Suite B, Pocatello, ID 83201-2789 | 2007-05-07 |
| 1821210535 | Bryce Robert Larsen | Dentist | 950 Hospital Way, Suite B, Pocatello, ID 83201-2789 | 2007-05-03 |
| 1366508954 | Yost and Yost Pediatrics | Pediatrics | 950 Hospital Way, Suite A, Pocatello, ID 83201-2789 | 2006-12-28 |
| 1528092202 | Christopher R Johnson | Family Medicine | 950 Hospital Way, Suite A, Pocatello, ID 83201-2789 | 2006-07-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801292115 | Idaho State University | Family Medicine | 921 S 8th Ave Stop 8173, Sports and Orthopaedic Center, Pocatello, ID 83209-8173 | 2014-11-13 |
| 1659870517 | Orthoidaho LLC | Family Medicine | 2240 E Center St, Pocatello, ID 83201-2600 | 2018-02-06 |
| 1770877888 | Anthony Joseph Md Inc | Family Medicine | 333 N 18th Ave, Suite D-1, Pocatello, ID 83201-3358 | 2011-06-06 |
| 1528092202 | Christopher R Johnson | Family Medicine | 950 Hospital Way, Suite A, Pocatello, ID 83201-2789 | 2006-07-10 |
| 1922092741 | Anthony E Joseph | Family Medicine | 2240 E Center St, Pocatello, ID 83201-2600 | 2005-09-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407237043 | Jacob Kent Christensen | Family Medicine | 831 S Ash St, Moscow, ID 83843 | 2015-06-09 |
| 1508152257 | Tobias P Gopon | Family Medicine | 600 N Robbins Rd Ste 400, Boise, ID 83702-4566 | 2011-06-21 |
| 1215137526 | Dean Edward Lapinel | Family Medicine | 1437 E Braemere Rd, Boise, ID 83702-1857 | 2007-07-24 |
| 1881629202 | Craig M Smith | Family Medicine | 5959 N Discovery Place, Boise, ID 83713-1556 | 2006-07-12 |
| 1477581122 | Kurt J Nilsson | Family Medicine | 1109 W Myrtle St, Suite 200, Boise, ID 83702-6970 | 2006-06-30 |
| 1366822892 | Kaleb Redden | Family Medicine | 777 N Raymond St, Boise, ID 83704-9251 | 2015-05-29 |
| 1295094217 | James Kendall Christensen | Family Medicine | 2375 E Sunnyside Rd, Ste F, Idaho Falls, ID 83404-8280 | 2012-05-11 |
| 1417143926 | Richard Radnovich Do PC | Family Medicine | 4850 N Rosepoint Way, Suite 100, Boise, ID 83713-5262 | 2007-09-18 |
| 1407944655 | Richard Radnovich | Family Medicine | 4850 N Rosepoint Way, Ste 100, Boise, ID 83713 | 2006-10-11 |
| 1124115944 | Tony C Roisum Md Pa | Family Medicine | 3360 Washington Pkwy, Suite 1, Idaho Falls, ID 83404-8333 | 2006-10-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.