1. Home
  2. Directory
  3. Idaho
  4. Pocatello
  5. Family Medicine
  6. NPI Profile

IDAHO MODERN MEDICINE - PLLC
NPI 1184255754
Family Medicine in Pocatello, ID

Active since January 31, 2020CLIA 13D2178927 · Waiver
1000 POCATELLO CREEK RD STE E10, POCATELLO, ID 83201(208) 317-5371 Get Directions Write a Review

NPPES record last updated: February 5, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Feb 5, 2024, Jun 17, 2021, Feb 12, 2020 and 2 more (5 updates tracked since 2020).

About Idaho Modern Medicine - Pllc NPPES

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

IDAHO MODERN MEDICINE - PLLC (NPI 1184255754) is a healthcare organization registered as a family medicine in Pocatello, Idaho and active in the NPI registry since January 2020. The organization holds a CLIA Waiver certificate valid through February 10, 2028 and lists Michael A Anderson, Physician / Owner, as its authorized official.

NPPES Registry Identity

NPI1184255754
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameIDAHO MODERN MEDICINE - PLLC
Location Address1000 POCATELLO CREEK RD STE E10Pocatello, ID 83201-2953
Mailing Address1000 Pocatello Creek Rd Ste E10Pocatello, ID 83201-2953 · (208) 648-4789 · Fax (208) 648-4790
Phone(208) 317-5371
Organization SubpartNo
Authorized OfficialMichael A AndersonPhysician / Owner · (208) 648-4789
Enumeration DateJanuary 31, 2020
Last NPPES UpdateFebruary 5, 20245 updates tracked since enumeration
NPPES CertifiedFebruary 5, 2024
✔ NPI 1184255754 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
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.
1000 POCATELLO CREEK RD STE E10, Pocatello, ID 83201
Open in Google Maps ↗

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 Moda Health Plan, Inc..Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Idaho Modern Medicine - Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Idaho Modern Medicine - PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Michael Anderson, DO
Family Practice
NPI 1124406186
1000 POCATELLO CREEK RD STE E10
Pocatello, ID 83201
(208) 648-4789
✔ PECOS✔ Accepts MedicareSame address

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

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 of Waiver 13D2178927

Idaho Modern Medicine · Pocatello, ID
Active · expires Feb 10, 2028
CLIA Number13D2178927
Laboratory TypePhysician Office
Certificate Effective DateFebruary 11, 2026
Certificate Expiration DateFebruary 10, 2028
Laboratory DirectorMichael A. Anderson
Laboratory Phone(208) 648-4789
Laboratory LocationIdaho Modern Medicine1000 Pocatello Cr Rd Ste E10, Pocatello, ID 83201
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Modern Medicine - PLLC's NPI number?

The NPI number for Idaho Modern Medicine - PLLC is 1184255754. It was assigned to this organization in the NPPES registry on January 31, 2020.

Where is Idaho Modern Medicine - PLLC located?

Idaho Modern Medicine - PLLC is located at 1000 Pocatello Creek Rd Ste E10, Pocatello, ID 83201. The listed phone number is (208) 317-5371.

What is Idaho Modern Medicine - PLLC's specialty?

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

Is Idaho Modern Medicine - PLLC enrolled in Medicare?

Yes. Idaho Modern Medicine - PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Idaho Modern Medicine - PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Idaho Modern Medicine - 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.

Does Idaho Modern Medicine - PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 13D2178927) is associated with this NPI, valid through February 10, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Idaho Modern Medicine - PLLC accept?

Health plans from Moda Health Plan, Inc. list Idaho Modern Medicine - PLLC 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 Idaho Modern Medicine - PLLC was last updated on February 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.