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PRISM FAMILY MEDICINE LLC
NPI 1942028592
Family Medicine in Pocatello, ID

Active since October 02, 2024
1950 E CLARK ST STE 100, POCATELLO, ID 83201(208) 806-4581(208) 837-3010 Get Directions Write a Review

NPPES record last updated: October 3, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Prism Family Medicine Llc NPPES

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

PRISM FAMILY MEDICINE LLC (NPI 1942028592) is a healthcare organization registered as a family medicine in Pocatello, Idaho and active in the NPI registry since October 2024. The organization lists Jessica J Rolynn, Owner, as its authorized official.

NPPES Registry Identity

NPI1942028592
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePRISM FAMILY MEDICINE LLC
Location Address1950 E CLARK ST STE 100Pocatello, ID 83201-3315
Mailing Address1950 E Clark St Ste 100Pocatello, ID 83201-3315
Phone(208) 806-4581
Fax(208) 837-3010
Organization SubpartNo
Authorized OfficialJessica J RolynnOwner · (208) 806-4581
Enumeration DateOctober 2, 2024
Last NPPES UpdateOctober 3, 2024
NPPES CertifiedOctober 3, 2024
✔ NPI 1942028592 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
1950 E CLARK ST STE 100, Pocatello, ID 83201
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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., Molina Healthcare.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)

Prism Family Medicine Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Prism Family Medicine LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jessica Rolynn, MD
Family Practice
NPI 1821652199
465 MEMORIAL DR
Pocatello, ID 83201
(208) 234-4700
✔ PECOS✔ Accepts Medicare0.4 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 13D2312984

Prism Family Medicine LLC · Pocatello, ID
Expired · Oct 21, 2026
CLIA Number13D2312984
Laboratory TypePhysician Office
Certificate Effective DateOctober 22, 2024
Certificate Expiration DateOctober 21, 2026
Laboratory DirectorJessica J. Rolynn
Laboratory Phone(208) 806-4581
Laboratory LocationPrism Family Medicine LLC1950 E Clark St Ste 100, Pocatello, ID 83201
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 Prism Family Medicine LLC's NPI number?

The NPI number for Prism Family Medicine LLC is 1942028592. It was assigned to this organization in the NPPES registry on October 2, 2024.

Where is Prism Family Medicine LLC located?

Prism Family Medicine LLC is located at 1950 E Clark St Ste 100, Pocatello, ID 83201. The listed phone number is (208) 806-4581.

What is Prism Family Medicine LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Prism Family Medicine LLC enrolled in Medicare?

Yes. Prism Family Medicine LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Prism Family Medicine LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Prism Family Medicine LLC. 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 Prism Family Medicine LLC accept?

Health plans from Moda Health Plan, Inc. and Molina Healthcare list Prism Family Medicine LLC 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 Prism Family Medicine LLC was last updated on October 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.