NPI age
13 years
Enumerated 2012-08-07
● Active Type 2 · Organization
Pocatello Family Medicine
Pocatello Family Medicine is 1 of 104 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Johnson
Office Manager
Last NPPES update
2012-08-07
Source: monthly bulk 2026-05
How this organization compares
Across 104 active clinic/center providers in Idaho.
NPI age
13 years
↑ 2 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2012 → 2026
2012-08Enumerated in NPPES
2012
2026
Where they practice
Primary practice location
465 Memorial Drive
Pocatello, ID 832014008
Mailing address
465 Memorial Dr
Pocatello, ID 832014008
Authorized official
Rose Johnson
Office Manager
📞 2082824421
Individual providers at this organization
2 individual providers on file at this primary practice address.
- Stephen Grandy, DDS Dentist NPI 1407261407
- Daniel Yates, D.M.D. Dentist NPI 1972850444
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Multi-provider organization. 2 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.