NPI age
8 years
Enumerated 2017-07-19
● Active Type 2 · Organization
Subpart
Portneuf Asc, Llc
Portneuf Asc, Llc is 1 of 99 clinic/center organizations in Idaho.
Primary specialty
Clinic/Center
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Petrovich
Evp
Last NPPES update
2017-07-19
Source: monthly bulk 2026-05
How this organization compares
Across 99 active clinic/center providers in Idaho.
NPI age
8 years
↓ 10 yr below median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2017 → 2026
2017-07Enumerated in NPPES
2017
2026
Where they practice
Primary practice location
1151 Hospital Way Bldg A
Pocatello, ID 832015091
Mailing address
1 Burton Hills Blvd Ste 250
Nashville, TN 372156195
Authorized official
Stephen C Petrovich
Evp
📞 6152963000
Individual providers at this organization
6 individual providers on file at this primary practice address.
- Darryl Cook, M.D. Internal Medicine NPI 1972525111
- Thomas Davis, D.O. Internal Medicine NPI 1295757433
- Charles Evans, M.D. Internal Medicine NPI 1992727143
- Matthew Gregson, PA-C Physician Assistant NPI 1710358007
- Shad Johnson, PA-C Physician Assistant NPI 1114028354
- Brandon Scott, D.O. Internal Medicine NPI 1972980548
Specialties
-
Clinic/Center PrimaryDefinition to come...
Practice context
Multi-provider organization. 6 individual providers on file at this primary address.
Subpart of Pocatello Health System, Llc.
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Request a quote →How to verify this organization
- 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.