PORTNEUF ASC, LLC
NPI 1871016071
Clinic/Center - Ambulatory Surgical in Pocatello, ID

Q: What is Portneuf ASC, LLC's NPI number?

The NPI number for Portneuf ASC, LLC is 1871016071. It was assigned to this organization in the NPPES registry on July 19, 2017.

Q: What is Portneuf ASC, LLC's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Portneuf ASC, LLC was last updated on July 19, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 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.

Active since July 19, 2017CLIA 13D0982472 · Waiver

1151 HOSPITAL WAY BLDG A, POCATELLO, ID 83201(208) 232-6616(208) 232-6618 Get Directions Write a Review

NPPES record last updated: July 19, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Portneuf Asc, Llc NPPES

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

PORTNEUF ASC, LLC (NPI 1871016071) is a healthcare organization registered as an ambulatory surgical in Pocatello, Idaho and active in the NPI registry since July 2017. The organization holds a CLIA Waiver certificate valid through January 25, 2027 and lists Stephen C Petrovich, Evp, as its authorized official.

NPPES Registry Identity

NPI1871016071

Entity TypeOrganization

Primary Taxonomy261QA1903X

Legal Business NamePORTNEUF ASC, LLC

Location Address1151 HOSPITAL WAY BLDG APocatello, ID 83201-5091

Mailing Address1 Burton Hills Blvd Ste 250Nashville, TN 37215-6195 · (615) 296-3000 · Fax (615) 296-6227

Phone(208) 232-6616

Fax(208) 232-6618

Organization SubpartYesParent: Pocatello Health System, Llc

Authorized OfficialStephen C PetrovichEvp · (615) 296-3000

Enumeration DateJuly 19, 2017

✔ NPI 1871016071 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Ambulatory SurgicalAmbulatory Health Care Facilities

Taxonomy Code261QA1903X

1151 HOSPITAL WAY BLDG A, Pocatello, ID 83201

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Accepted Insurance

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

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 13D0982472

Portneuf ASC LLC Dba Portneuf Endoscopy Center · Pocatello, ID

Active · expires Jan 25, 2027

CLIA Number13D0982472

Laboratory TypeAmbulatory Surgery Center

Certificate Effective DateJanuary 26, 2025

Certificate Expiration DateJanuary 25, 2027

Laboratory DirectorJonathan Godfrey

Laboratory Phone(208) 232-6616

Laboratory LocationPortneuf ASC LLC Dba Portneuf Endoscopy Center1151 #a Hospital Way, Pocatello, ID 83201

CLIA data matches this NPI record on: Name Phone

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.

Biopsy of large bowel using a flexible endoscope 45380

A biopsy of the large bowel using a flexible endoscope is a procedure where a thin, flexible tube with a camera is inserted through the rectum to examine the bowel. If abnormal tissue is found, a small sample is taken for further examination. This helps in diagnosing conditions like inflammation, polyps, or cancer.

145 services145 patients

Removal of polyps or growths of large bowel using an endoscope with mechanical snare 45385

This procedure involves using a thin, flexible tube called an endoscope to examine the large bowel. If any abnormal growths or polyps are found, a tool called a mechanical snare is used to remove them. This is a common method to prevent potential health issues.

135 services135 patients

Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope 43239

This procedure involves using a thin, flexible tube with a light and camera, known as an endoscope, to examine the esophagus, stomach, and upper part of the small intestine. Small tissue samples are taken for further examination to help diagnose various conditions.

93 services93 patients

Colorectal cancer screening; colonoscopy on individual at high risk G0105

Colorectal cancer screening, specifically a colonoscopy, is a preventive measure for those at high risk. A thin, flexible tube with a camera inspects the colon to spot any abnormal growths. This test helps detect potential issues early, enhancing the effectiveness of treatment.

31 services31 patients

Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0121

Colorectal cancer screening, such as a colonoscopy, is a preventive measure to detect early signs of cancer in the large intestine. For individuals not at high risk, it's typically recommended at age 50. A small, flexible tube with a camera is used to examine your colon. It's a safe, effective way to catch issues early.

30 services30 patients

Insertion of guide wire with dilation of esophagus using a flexible endoscope 43248

This is a procedure where a thin tube, called an endoscope, is gently passed through your mouth into your esophagus. A guide wire is then inserted to help widen any narrow areas. This helps improve swallowing and reduce discomfort.

16 services16 patients

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Other Providers at the Same Location NPPES 8

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

SHAD CARL JOHNSON PA-C

Physician Assistant (Medical)