IDAHO FALLS DERMATOLOGY P A
NPI 1487700464
Specialist in Idaho Falls, ID
About Idaho Falls Dermatology P A NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IDAHO FALLS DERMATOLOGY P A (NPI 1487700464) is a healthcare organization registered as a specialist in Idaho Falls, Idaho and active in the NPI registry since January 2007. The organization holds a CLIA Certificate of Compliance certificate valid through July 19, 2027 and lists Cornelius Paul Brooke, M.d., as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 4
Group Practice 1
Accepted 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 Falls Dermatology P A is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Idaho Falls Dermatology P A, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
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 Compliance 13D1063459
Idaho Falls Dermatology · Idaho Falls, IDFrequently 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 Dermatology P A's NPI number?
The NPI number for Idaho Falls Dermatology P A is 1487700464. It was assigned to this organization in the NPPES registry on January 25, 2007.
Where is Idaho Falls Dermatology P A located?
Idaho Falls Dermatology P A is located at 2001 S Woodruff Ave Ste 12A, Idaho Falls, ID 83404. The listed phone number is (208) 522-8945.
What is Idaho Falls Dermatology P A's specialty?
The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.
Is Idaho Falls Dermatology P A enrolled in Medicare?
Yes. Idaho Falls Dermatology P A is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Idaho Falls Dermatology P A?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Dermatology, reassign their Medicare billing to Idaho Falls Dermatology P A. 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. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Idaho Falls Dermatology P A hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 13D1063459) is associated with this NPI, valid through July 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Idaho Falls Dermatology P A accept?
Health plans from Molina Healthcare and University of Utah Health Plans list Idaho Falls Dermatology P A 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 Dermatology P A was last updated on July 5, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.
# Idaho Falls Dermatology P A · NPI 1487700464
Specialist organization in Idaho Falls, Idaho. Organization record, active in the CMS NPPES registry since January 25, 2007.
## Identity
- **NPI:** 1487700464 (Entity type: Organization)
- **Enumerated:** January 25, 2007
- **Primary specialty:** Specialist · taxonomy 174400000X
- **Organization subpart:** No
- **Authorized official:** Cornelius Brooke, M.D.
## Practice location
- **Address:** 2001 S WOODRUFF AVE, STE 12A, Idaho Falls, ID 83404-6374
- **Phone:** (208) 522-8945
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Dermatology) reassign Medicare billing to this organization (form CMS-855R); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 5, 2016
- **Other identifiers:** Other 77186 (ID); Medicare ID-Type Unspecified 1124989; Medicare UPIN E23470; and 1 more
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1487700464) · Data from the CMS NPPES public registry.