Mountain Crest Foot and Ankle PA
NPI 1932191996ActiveOrganization· Podiatrist· Idaho Falls, ID
Podiatrist in Idaho Falls, Idaho, registered in NPPES in August 2005. The authorized official on file is Timothy Roger Black, DPM, Owner/Physician. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1932191996 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 16, 2005 |
| Last updated in NPPES | Dec 6, 2010 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Podiatrist Primary | 213E00000X | P-169 | 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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