NPI age
15 years
Enumerated 2011-03-01
● Active Type 2 · Organization
Idaho Sports & Spine Pllc
Idaho Sports & Spine Pllc is 1 of 26 family medicine organizations in Idaho.
Primary specialty
Family Medicine
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Hansen
Owner
Last NPPES update
2019-11-04
Source: monthly bulk 2026-05
How this organization compares
Across 26 active family medicine providers in Idaho.
NPI age
15 years
≈ at median (14 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2011 → 2026
2011-03Enumerated in NPPES
2011
2026
Where they practice
Primary practice location
950 Hospital Way, Ste A
Pocatello, ID 832012789
Mailing address
950 Hospital Way, Ste A
Pocatello, ID 832012789
Authorized official
Stephen Hansen, D.O.
Owner
📞 2084784522
Individual providers at this organization
5 individual providers on file at this primary practice address.
- Jenna Castillo, PA-C Physician Assistant NPI 1326651035
- Gregory Ford, MD Orthopaedic Surgery NPI 1104928670
- Bryce Larsen, D.M.D. Dentist NPI 1821210535
- Niels Larsen, D.D.S. Dentist NPI 1770796070
- Tanner Mitton, PA-C Physician Assistant NPI 1144601865
Specialties
-
Family Medicine PrimaryA family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine...
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Christopher R Johnson DO, PLLC
Practice context
Multi-provider organization. 5 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.