Idaho Falls Dermatology P A
NPI 1487700464ActiveOrganization· Specialist· Idaho Falls, ID
Specialist in Idaho Falls, Idaho, registered in NPPES in January 2007. The authorized official on file is Cornelius Paul Brooke, M.D. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1487700464 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 25, 2007 |
| Last updated in NPPES | Jul 5, 2016 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X | 5809M | ID |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (ID) |
|---|
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