NPI age
19 years
Enumerated 2006-10-05
● Active Type 2 · Organization
Tony C Roisum MD PA
Tony C Roisum MD PA is 1 of 1691 family medicine organizations in Idaho.
Primary specialty
Family Medicine
Plus 1 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Kelsey
Office Manager
Last NPPES update
2026-01-16
Source: monthly bulk 2026-05
How this organization compares
Across 1691 active family medicine providers in Idaho.
NPI age
19 years
↑ 2 yr above median
Practice locations
1
0 secondary on file
Subspecialties
1
In the 31% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-10Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
3360 Washington Pkwy, Suite 1
Idaho Falls, ID 834048333
Mailing address
3360 Washington Pkwy Ste 1
Idaho Falls, ID 834047592
Authorized official
Jacqueline Kelsey
Office Manager
📞 2085243416
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Alan Jensen, PA Physician Assistant NPI 1821370461
Specialties
-
Family Medicine PrimaryFamily 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 MedicineA 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...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 000010004286 | BLUE SHIELD |
| 01 | B5824 | BLUE CROSS |
| 01 (ID) | DJ475 | BLUE CROSS |
| 05 (WY) | 119166700 | |
| 01 (ID) | 185461600 | US DEPT OF LABOR |
| 05 (UT) | 502862456001 | |
| 01 | 23397 | BLUE SHIELD |
| 05 (ID) | 805076700 |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Idaho Falls Family & Sports Medicine
Practice context
Multi-provider organization. 1 individual provider 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.