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IDAHO FALLS PEDIATRICS
NPI 1366560971
Pediatrics - Adolescent Medicine in Ammon, ID

Active since March 26, 2007CLIA Certified · 2 labs
3067 EAGLE DR, AMMON, ID 83406(208) 522-4600(208) 552-7521 Get Directions Write a Review

NPPES record last updated: December 5, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 5, 2024, Aug 22, 2020 (2 updates tracked since 2020).

About Idaho Falls Pediatrics NPPES

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

IDAHO FALLS PEDIATRICS (NPI 1366560971) is a healthcare organization registered as an adolescent medicine in Ammon, Idaho and active in the NPI registry since March 2007. The organization holds 2 active CLIA laboratory certificates and lists Ron Wade Porter, Owner, as its authorized official.

NPPES Registry Identity

NPI1366560971
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameIDAHO FALLS PEDIATRICS
Location Address3067 EAGLE DRAmmon, ID 83406-1273
Mailing Address3067 Eagle DrAmmon, ID 83406-1273 · (208) 522-4600 · Fax (208) 552-7521
Phone(208) 522-4600
Fax(208) 552-7521
Organization SubpartNo
Authorized OfficialRon Wade PorterOwner · (208) 522-4600
Enumeration DateMarch 26, 2007
Last NPPES UpdateDecember 5, 20242 updates tracked since enumeration
NPPES CertifiedDecember 5, 2024
✔ NPI 1366560971 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in ID · M7271
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
3067 EAGLE DR, Ammon, ID 83406
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

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

CLIA Laboratory Certificates CMS CLIA 2

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 13D0969818

Idaho Falls Pediatrics · Ammon, ID
Active · expires Mar 9, 2028
CLIA Number13D0969818
Laboratory TypePhysician Office
Certificate Effective DateMarch 10, 2026
Certificate Expiration DateMarch 9, 2028
Laboratory DirectorScott Smith
Laboratory Phone(208) 522-4600
Laboratory LocationIdaho Falls Pediatrics3067 Eagle Dr, Ammon, ID 83406
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 13D2085610

Idaho Falls Pediatrics-Westside · Idaho Falls, ID
Active · expires Sep 10, 2026
CLIA Number13D2085610
Laboratory TypePhysician Office
Certificate Effective DateSeptember 11, 2024
Certificate Expiration DateSeptember 10, 2026
Laboratory DirectorRon Porter
Laboratory Phone(208) 522-4600
Laboratory LocationIdaho Falls Pediatrics-Westside1645 Pancheri Dr, Idaho Falls, ID 83402
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

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

DR. SCOTT ALAN SMITH D.O.
Pediatrics
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600
KAMLYN HARKER PA
Physician Assistant
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600
DR. MITCHAEL CONRAD STEORTS M.D.
Pediatrics (Adolescent Medicine)
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600
MR. DAVID DEAN BUYS PA-C
Physician Assistant (Medical)
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600
MISS JACQUELINE ROMRELL NP
Nurse Practitioner (Family)
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600
AVERY C HALL PA-C
Physician Assistant
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600
DR. JEFFREY WEBB DO
Pediatrics
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600
DR. JOSEPH REED MOORE M.D.
Pediatrics
3067 EAGLE DR
AMMON, ID 83406
Bonneville County (208) 522-4600

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 Falls Pediatrics's NPI number?

The NPI number for Idaho Falls Pediatrics is 1366560971. It was assigned to this organization in the NPPES registry on March 26, 2007.

Where is Idaho Falls Pediatrics located?

Idaho Falls Pediatrics is located at 3067 Eagle Dr, Ammon, ID 83406. The listed phone number is (208) 522-4600.

What is Idaho Falls Pediatrics's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Idaho Falls Pediatrics hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Idaho Falls Pediatrics accept?

Health plans from Moda Health Plan, Inc. and University of Utah Health Plans list Idaho Falls Pediatrics 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 Falls Pediatrics was last updated on December 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.