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IDAHO SPORTS & SPINE PLLC
NPI 1033417035
Family Medicine - Sports Medicine in Pocatello, ID

Active since March 01, 2011
950 HOSPITAL WAY, STE A, POCATELLO, ID 83201(208) 478-4522(208) 478-2935 Get Directions Write a Review

NPPES record last updated: November 4, 2019. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Idaho Sports & Spine Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IDAHO SPORTS & SPINE PLLC (NPI 1033417035), doing business as Christopher R Johnson Do, Pllc, is a healthcare organization registered as a sports medicine in Pocatello, Idaho and active in the NPI registry since March 2011. The organization lists Stephen Hansen, Owner, as its authorized official.

NPPES Registry Identity

NPI1033417035
Entity TypeOrganization
Primary Taxonomy207QS0010X
Legal Business NameIDAHO SPORTS & SPINE PLLC
Location Address950 HOSPITAL WAY, STE APocatello, ID 83201-2789
Mailing Address950 Hospital Way, Ste APocatello, ID 83201-2789 · (208) 478-4522 · Fax (208) 478-2935
Phone(208) 478-4522
Fax(208) 478-2935
Organization SubpartNo
Authorized OfficialStephen HansenOwner · (208) 478-4522
Enumeration DateMarch 1, 2011
Last NPPES UpdateNovember 4, 2019
✔ NPI 1033417035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QS0010X
License✔ Licensed in ID · O-0400
Definition
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.
950 HOSPITAL WAY, Pocatello, ID 83201
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Other Names 1

Former Legal Business NameChristopher R Johnson Do, Pllc

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Idaho Sports & Spine Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by December 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateIdahoEnrollment IDO20110510000817Non-DME Part B · Clinic/Group PracticeDue dateDecember 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Idaho Sports & Spine PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Stephen Hansen, M.D.
Orthopedic Surgery
NPI 1164491460
950 HOSPITAL WAY STE A
Pocatello, ID 83201
(208) 478-4522
✔ PECOS✔ Accepts Medicare0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Idaho Sports & Spine PLLC's NPI number?

The NPI number for Idaho Sports & Spine PLLC is 1033417035. It was assigned to this organization in the NPPES registry on March 1, 2011. The provider was formerly known as Christopher R Johnson Do, PLLC.

Where is Idaho Sports & Spine PLLC located?

Idaho Sports & Spine PLLC is located at 950 Hospital Way Ste A, Pocatello, ID 83201. The listed phone number is (208) 478-4522.

What is Idaho Sports & Spine PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Is Idaho Sports & Spine PLLC enrolled in Medicare?

Yes. Idaho Sports & Spine PLLC is registered in the Medicare PECOS enrollment system.

When is Idaho Sports & Spine PLLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Idaho, Clinic/Group Practice) is due for revalidation by December 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Idaho Sports & Spine PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Orthopedic Surgery) reassigns their Medicare billing to Idaho Sports & Spine PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Idaho Sports & Spine PLLC was last updated on November 4, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.