IDAHO FALLS FAMILY & SPORTS MEDICINE
NPI 1124115944
Family Medicine in Idaho Falls, ID

Q: What is Tony C Roisum MD PA's NPI number?

The NPI number for Tony C Roisum MD PA is 1124115944. It was assigned to this organization in the NPPES registry on October 5, 2006. The provider is doing business as Idaho Falls Family & Sports Medicine.

Q: What is Tony C Roisum MD PA's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Active since October 05, 2006CLIA 13D0936394 · Microscopy

3360 WASHINGTON PKWY, SUITE 1, IDAHO FALLS, ID 83404(208) 524-3416(208) 524-3138 Get Directions Write a Review

NPPES record last updated: May 20, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 16, 2026, May 20, 2016 (2 updates tracked since 2016).

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About Idaho Falls Family & Sports Medicine NPPES

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

IDAHO FALLS FAMILY & SPORTS MEDICINE (NPI 1124115944) is a healthcare organization registered as a family medicine in Idaho Falls, Idaho and active in the NPI registry since October 2006. The organization holds a CLIA Microscopy certificate valid through November 19, 2027 and lists Tony C Roisum, Owner / President, as its authorized official.

NPPES Registry Identity

NPI1124115944

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameTONY C ROISUM MD PA

Location Address3360 WASHINGTON PKWY, SUITE 1Idaho Falls, ID 83404-8333

Mailing Address3360 Washington Pkwy, Suite 1Idaho Falls, ID 83404-8333 · (208) 524-3416 · Fax (208) 524-3138

Phone(208) 524-3416

Fax(208) 524-3138

Organization SubpartNo

Authorized OfficialTony C RoisumOwner / President · (208) 524-3416

Enumeration DateOctober 5, 2006

Last NPPES UpdateMay 20, 20162 updates tracked since enumeration

✔ NPI 1124115944 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

License✔ Licensed in ID · M7389

Definition

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.

Also ListedFamily Medicine · Sports MedicineTaxonomy 207QS0010X · License M7389 (ID)

3360 WASHINGTON PKWY, Idaho Falls, ID 83404

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Other Names 1

Doing Business AsIdaho Falls Family & Sports Medicine

Other Identifiers 12

Other185461600ID · Us Dept Of Labor

OtherB5824Blue Cross

Medicare ID-Type Unspecified1138391ID

OtherDJ475ID · Blue Cross

Medicare ID-Type Unspecified080120741ID · Railroad Medicare

Medicaid119166700WY

Other000010004286ID · Blue Shield

Medicare UPINF29375ID

Medicaid502862456001UT

Medicare PIN1138391

Other23397Blue Shield

Medicaid805076700ID

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include University of Utah Health Plans.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 13D0936394

Idaho Falls Family & Sports Medicine · Idaho Falls, ID

Active · expires Nov 19, 2027

CLIA Number13D0936394

Laboratory TypePhysician Office

Certificate Effective DateNovember 20, 2025

Certificate Expiration DateNovember 19, 2027

Laboratory DirectorTony C. Roisum

Laboratory Phone(208) 524-3416

Laboratory LocationIdaho Falls Family & Sports Medicine3360 Washington Pkwy #1, Idaho Falls, ID 83404

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALAN JOEL JENSEN PA

Physician Assistant (Medical)

3360 WASHINGTON PKWY, SUITE 2
IDAHO FALLS, ID 83404

Bonneville County (208) 528-8170

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 Tony C Roisum MD PA's NPI number?

The NPI number for Tony C Roisum MD PA is 1124115944. It was assigned to this organization in the NPPES registry on October 5, 2006. The provider is doing business as Idaho Falls Family & Sports Medicine.

Where is Tony C Roisum MD PA located?

Tony C Roisum MD PA is located at 3360 Washington Pkwy Suite 1, Idaho Falls, ID 83404. The listed phone number is (208) 524-3416.

What is Tony C Roisum MD PA's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Tony C Roisum MD PA hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 13D0936394) is associated with this NPI, valid through November 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Tony C Roisum MD PA accept?

Health plans from University of Utah Health Plans list Tony C Roisum MD PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tony C Roisum MD PA was last updated on May 20, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.