TONY C ROISUM MD PA (NPI# 1124115944) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124115944 |
| Entity Type | Organization |
| Organization Name | TONY C ROISUM MD PA |
| Other Organization Name | IDAHO FALLS FAMILY & SPORTS MEDICINE |
| Practice Address |
3360 Washington Pkwy Suite 1 Idaho Falls ID 83404-8333 |
| Practice Telephone | 2085243416 |
| Practice Fax Number | 2085243138 |
| Mailing Telephone | 2085243416 |
| Mailing Fax Number | 2085243138 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-05-20 |
| NPI Deactivation Date | 07/24/2007 |
| NPI Reactivation Date | 2008-12-09 |
| Authorized Official Name | TONY C ROISUM (OWNER / PRESIDENT) |
| Authorized Official Telephone | 2085243416 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
M7389 | ID | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | M7389 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE SHIELD | 000010004286 | 01 |
| BLUE SHIELD | 23397 | 01 | |
| WY | 119166700 | 05 | |
| ID | 805076700 | 05 | |
| BLUE CROSS | B5824 | 01 | |
| ID | US DEPT OF LABOR | 185461600 | 01 |
| UT | 502862456001 | 05 | |
| ID | BLUE CROSS | DJ475 | 01 |
| Other Name | Type Code |
|---|---|
| Idaho Falls Family & Sports Medicine | Doing Business As Name - Organization |
| Street Address |
3360 WASHINGTON PKWY SUITE 1 |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-8333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770688426 | Tony Craig Roisum | Family Medicine | 3360 Washington Pkwy, Suite 1, Idaho Falls, ID 83404-8332 | 2006-09-14 |
| 1821370461 | Alan Joel Jensen | Physician Assistant | 3360 Washington Pkwy, Suite 2, Idaho Falls, ID 83404-8332 | 2011-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, 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 Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740663806 | Rindfleisch Family Practice Pllc | Family Medicine | 4954 E Powerhouse Dr, Idaho Falls, ID 83406-5064 | 2015-07-07 |
| 1013204445 | Machen Family Medicine, PC | Family Medicine | 1995 E 17th St Ste A, Idaho Falls, ID 83404-6493 | 2011-07-06 |
| 1942521109 | Luke N/a Haws | Family Medicine | 2985 Cortez Ave Ste 200, Idaho Falls, ID 83404-7554 | 2010-06-22 |
| 1689993271 | David Lyle Hill | Family Medicine | 3242 S Woodruff, Idaho Falls, ID 83404-7531 | 2010-05-23 |
| 1912120544 | James William Brook | Family Medicine | 905 Austin Ave, Idaho Falls, ID 83404 | 2007-04-11 |
| 1437294345 | Oliver Daniel Smith | Family Medicine | 3669 Ellendale Circle, Idaho Falls, ID 83406 | 2007-02-20 |
| 1023151156 | Physician Skin Care | Family Medicine | 730 S Woodruff Ave, Idaho Falls, ID 83401-5285 | 2007-02-15 |
| 1598837031 | Anne L Broadway | Family Medicine | 2730 Channing Way, Idaho Falls, ID 83404-5049 | 2006-11-13 |
| 1235217506 | Reed Ivol Ward | Family Medicine | 3425 Potomac Way, Idaho Falls, ID 83404-4970 | 2006-11-02 |
| 1770688426 | Tony Craig Roisum | Family Medicine | 3360 Washington Pkwy, Suite 1, Idaho Falls, ID 83404-8332 | 2006-09-14 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
Please comment or provide details below to improve the information on TONY C ROISUM MD PA.
| 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.