NPI age
18 years
Enumerated 2007-05-29
● Active Type 2 · Organization
Wallace Bakers Mid-Level Group
Wallace Bakers Mid-Level Group is 1 of 387 physician assistant organizations in Idaho.
Primary specialty
Physician Assistant
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Baker
Ceo
Last NPPES update
2020-08-22
Source: monthly bulk 2026-05
How this organization compares
Across 387 active physician assistant providers in Idaho.
NPI age
18 years
↑ 3 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2007 → 2026
2007-05Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
1880 John Adams Pkwy
Idaho Falls, ID 834014315
Mailing address
1880 John Adams Pkwy
Idaho Falls, ID 834014315
Authorized official
Wallace Coleman Baker, MD
Ceo
📞 2085246633
Individual providers at this organization
7 individual providers on file at this primary practice address.
- Wallace Baker, M.D. Family Medicine NPI 1083696967
- Jessica Christensen, FNP Nurse Practitioner NPI 1457913162
- Wade Christensen, P.A. Physician Assistant NPI 1386626463
- Telietha Hammon, FNP-BC Nurse Practitioner NPI 1942976592
- Joshua Hansen, PA-C Physician Assistant NPI 1588948087
- Rebecca Newby, PA-C Physician Assistant NPI 1457685265
- Laura Tabor, P.A. Physician Assistant NPI 1538121322
Specialties
-
Physician Assistant PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 8076593 |
Practice context
Multi-provider organization. 7 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 →
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- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.