HENRYS FORK SURGERY CENTER PLLC
NPI 1235768490
Clinic/Center - Ambulatory Surgical in Rexburg, ID
NPI Status: Active since April 08, 2020
Contact Information
23 SAWTELLE AVE
REXBURG, ID
ZIP 83440
Phone: (208) 359-1888
Fax: (208) 359-1889
- Organization
- Clinic/Center
- Ambulatory Surgical
- Accepts Insurance
- CLIA Number: 13D2193453
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 09-21-2026
About HENRYS FORK SURGERY CENTER PLLC
This page provides the complete NPI Profile along with additional information for Henrys Fork Surgery Center Pllc, a provider established in Rexburg, Idaho operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1235768490 assigned on April 2020. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated one year ago. The authorized official of this NPI record is Jeremy Johnson (Manager)
- NPI
- 1235768490
- Provider Name
- HENRYS FORK SURGERY CENTER PLLC
- Entity Type
- Organization
- Location Address
- 23 SAWTELLE AVE REXBURG, ID 83440
- Location Phone
- (208) 359-1888
- Location Fax
- (208) 359-1889
- Mailing Address
- PO BOX 6 REXBURG, ID 83440
- Mailing Phone
- (208) 359-1888
- Mailing Fax
- (208) 359-1889
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-08-2020
- Last Update Date
- 06-19-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Healthy Premier Bronze HSA - EPO
- Healthy Premier Expanded Bronze Standard - EPO
- Healthy Premier Gold Copay Office Visits - EPO
- Healthy Premier Gold Standard - EPO
- Healthy Premier Silver Copay Office Visits - EPO
- Healthy Premier Silver Standard - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1447301395 | MEDICAID (05) | ID |
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Removal of cataract with insertion of prosthetic lens
Removal of excessive skin and fat of upper eyelid
Removal of eye fluid (vitreous) between lens and retina
Removal of membrane of retina
Removal of membrane of retina with removal of internal limiting membrane of retina
This is a procedure where a cloudy lens in your eye, known as a cataract, is removed. After removal, a clear artificial lens is inserted. This helps to restore your vision, enabling you to see clearly again.
This service was performed 207 times for 122 patientsThis procedure, also known as upper eyelid surgery, is performed to remove excess skin and fat from the upper eyelid. It can help improve vision if heavy eyelids hinder it, and can also enhance the appearance of the eyes. It's a common, safe procedure.
This service was performed 52 times for 26 patientsThis procedure, known as a vitrectomy, involves removing some or all of the vitreous humor, the clear gel-like substance in the eye. It's done to treat various eye conditions, like retinal detachment or macular hole. The aim is to improve or stabilize vision. It's performed under local or general anesthesia.
This service was performed 65 times for 52 patientsRemoval of the retina's membrane is a surgical procedure aimed at treating eye conditions affecting the retina's function. It involves a delicate operation to eliminate scar tissue or membranes causing vision problems. The procedure can help improve or stabilize vision.
This service was performed 26 times for 25 patientsThis procedure involves the surgical removal of a thin layer, called the membrane, from the retina. It also includes the removal of the innermost layer of the retina, known as the internal limiting membrane. This can help improve vision.
This service was performed 20 times for 19 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 13D2193453
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- September 22, 2024
- Certificate Expiration Date
- September 21, 2026
- Laboratory Director
- JOSHUA R. FULLMER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Henrys Fork Surgery Center Pllc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1235768490, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 70. The final step is to find the difference between that total and the next multiple of ten (70 - 70 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 70 is 70. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1235768490, enumerated as an "organization" on April 08, 2020.
The provider is located at 23 SAWTELLE AVE REXBURG, ID 83440 and the phone number is (208) 359-1888.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: University of Utah Health Plans, Medicare and. Please consult your insurance carrier or call the provider to verify.
