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HENRYS FORK SURGERY CENTER PLLC
NPI 1235768490
Clinic/Center - Ambulatory Surgical in Rexburg, ID

Active since April 08, 2020
23 SAWTELLE AVE, REXBURG, ID 83440(208) 359-1888(208) 359-1889 Get Directions Write a Review

NPPES record last updated: June 19, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jun 19, 2025, Apr 8, 2020 (2 updates tracked since 2020).

About Henrys Fork Surgery Center Pllc NPPES

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

HENRYS FORK SURGERY CENTER PLLC (NPI 1235768490) is a healthcare organization registered as an ambulatory surgical in Rexburg, Idaho and active in the NPI registry since April 2020. The organization lists Jeremy Johnson, Manager, as its authorized official.

NPPES Registry Identity

NPI1235768490
Entity TypeOrganization
Primary Taxonomy261QA1903X
Legal Business NameHENRYS FORK SURGERY CENTER PLLC
Location Address23 SAWTELLE AVERexburg, ID 83440
Mailing AddressPo Box 6Rexburg, ID 83440-0006 · (208) 359-1888 · Fax (208) 359-1888
Phone(208) 359-1888
Fax(208) 359-1889
Organization SubpartNo
Authorized OfficialJeremy JohnsonManager · (208) 359-1888
Enumeration DateApril 8, 2020
Last NPPES UpdateJune 19, 20252 updates tracked since enumeration
NPPES CertifiedMay 20, 2025
✔ NPI 1235768490 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities
Taxonomy Code261QA1903X
23 SAWTELLE AVE, Rexburg, ID 83440
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Other Identifiers 1

Medicaid1447301395ID

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare, PacificSource Health Plans, Select Health and more.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)

Henrys Fork Surgery Center Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Henrys Fork Surgery Center PLLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (4)

Landon Thompson
Ophthalmology
NPI 1427640556
2100 PROVIDENCE WAY
Idaho Falls, ID 83404
(208) 529-6600
✔ PECOS✔ Accepts Medicare27 mi
Alex Wright, MD
Ophthalmology
NPI 1043715832
2100 PROVIDENCE WAY
Idaho Falls, ID 83404
(208) 529-6600
✔ PECOS✔ Accepts Medicare27 mi
Samuel Beckstead, DO
Ophthalmology
NPI 1487041380
5620 HARVEST SPRINGS BLVD
Chubbuck, ID 83202
(208) 232-4133
✔ PECOS✔ Accepts Medicare71 mi
Michael Burrow, MD
Ophthalmology
NPI 1124480868
5620 HARVEST SPRINGS BLVD
Chubbuck, ID 83202
(208) 232-4133
✔ PECOS✔ Accepts Medicare71 mi

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 13D2193453

Henry's Fork Surgery Center · Rexburg, ID
Expired · Sep 21, 2026
CLIA Number13D2193453
Laboratory TypeAmbulatory Surgery Center
Certificate Effective DateSeptember 22, 2024
Certificate Expiration DateSeptember 21, 2026
Laboratory DirectorJoshua R. Fullmer
Laboratory Phone(208) 356-0700
Laboratory LocationHenry's Fork Surgery Center23 Sawtelle Ave Ste 101, Rexburg, ID 83440
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of cataract with insertion of prosthetic lens 66984
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.
291 services167 patients
Removal of eye fluid (vitreous) between lens and retina 67036
This 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.
100 services76 patients
Removal of membrane of retina 67041
Removal 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.
36 services36 patients
Removal of excessive skin and fat of upper eyelid 15823
This 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.
29 services15 patients
Removal of membrane of retina with removal of internal limiting membrane of retina 67042
This 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.
19 services19 patients
Complex removal of cataract with insertion of prosthetic lens 66982
This procedure involves removing a cloudy lens (cataract) from your eye and replacing it with a clear, artificial lens. It helps restore vision that has been affected by the cataract. The operation is usually done under local anesthesia.
14 services12 patients

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 Henrys Fork Surgery Center PLLC's NPI number?

The NPI number for Henrys Fork Surgery Center PLLC is 1235768490. It was assigned to this organization in the NPPES registry on April 8, 2020.

Where is Henrys Fork Surgery Center PLLC located?

Henrys Fork Surgery Center PLLC is located at 23 Sawtelle Ave, Rexburg, ID 83440. The listed phone number is (208) 359-1888.

What is Henrys Fork Surgery Center PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.

Is Henrys Fork Surgery Center PLLC enrolled in Medicare?

Yes. Henrys Fork Surgery Center PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Henrys Fork Surgery Center PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Ophthalmology, reassign their Medicare billing to Henrys Fork Surgery Center 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.

What insurance does Henrys Fork Surgery Center PLLC accept?

Health plans from Molina Healthcare, PacificSource Health Plans, Select Health and University of Utah Health Plans list Henrys Fork Surgery Center 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 Henrys Fork Surgery Center PLLC was last updated on June 19, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.