IDAHO FALLS DERMATOLOGY P A
NPI 1487700464
Specialist in Idaho Falls, ID
NPI Status: Active since January 25, 2007
Contact Information
2001 S WOODRUFF AVE
STE 12A
IDAHO FALLS, ID
ZIP 83404
Phone: (208) 522-8945
- Organization
- Specialist
- Accepts Insurance
- CLIA Number: 13D1063459
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 07-19-2027
About IDAHO FALLS DERMATOLOGY P A
This page provides the complete NPI Profile along with additional information for Idaho Falls Dermatology P A, a provider established in Idaho Falls, Idaho operating as a Specialist. The healthcare provider is registered in the NPI registry with number 1487700464 assigned on January 2007. The practitioner's primary taxonomy code is 174400000X with license number 5809M (ID). The provider is registered as an organization and their NPI record was last updated 10 years ago. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Cornelius Paul Brooke (M.d.)
- NPI
- 1487700464
- Provider Name
- IDAHO FALLS DERMATOLOGY P A
- Entity Type
- Organization
- Location Address
- 2001 S WOODRUFF AVE STE 12A IDAHO FALLS, ID 83404
- Location Phone
- (208) 522-8945
- Mailing Address
- 2001 S WOODRUFF AVE STE 12A IDAHO FALLS, ID 83404
- Mailing Phone
- (208) 522-8945
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 01-25-2007
- Last Update Date
- 07-05-2016
- 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
Specialist
- Taxonomy Code
- 174400000X
- Type
- Other Service Providers
- License No.
- 5809M
- License State
- ID
- Taxonomy Description
- An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
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.
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 |
|---|---|---|---|
| 77186 | OTHER (01) | ID | BLUE CROSS |
| 1124989 | MEDICARE ID-TYPE UNSPECIFIED (04) | ||
| E23470 | MEDICARE UPIN (02) | ||
| 807962200 | MEDICAID (05) | ID |
CLIA 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
- 13D1063459
- Facility Type
- Physician Office
- Certificate Effective Date
- July 20, 2025
- Certificate Expiration Date
- July 19, 2027
- Laboratory Director
- PAUL C. BROOKE
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Idaho Falls Dermatology P A after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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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 1487700464, we treat the final digit (4) 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 56. The final step is to find the difference between that total and the next multiple of ten (60 - 56 = 4).
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 56 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
IDAHO FALLS, ID 83404
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1487700464, enumerated as an "organization" on January 25, 2007.
The provider is located at 2001 S WOODRUFF AVE STE 12A IDAHO FALLS, ID 83404 and the phone number is (208) 522-8945.
Specialist with taxonomy code 174400000X.
The provider might be accepting Accepts: University of Utah Health Plans, Blue Cross Blue. Please consult your insurance carrier or call the provider to verify.
