NPI age
20 years
Enumerated 2005-08-16
● Active Type 2 · Organization
Mountain Crest Foot And Ankle PA
Mountain Crest Foot And Ankle PA is 1 of 68 podiatrist organizations in Idaho.
Primary specialty
Podiatrist
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Black
Owner/physician
Last NPPES update
2010-12-06
Source: monthly bulk 2026-05
How this organization compares
Across 68 active podiatrist providers in Idaho.
NPI age
20 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2005 → 2026
2005-08Enumerated in NPPES
2005
2026
Where they practice
Primary practice location
3652 Washington Pkwy
Idaho Falls, ID 834047573
Mailing address
3652 Washington Pkwy
Idaho Falls, ID 834047573
Authorized official
Timothy Roger Black, DPM
Owner/physician
📞 2085288700
Individual providers at this organization
4 individual providers on file at this primary practice address.
- Timothy Black, DPM Podiatrist NPI 1578753091
- Jaxson Landon, DC Chiropractor NPI 1356064141
- Carmen Radford, LNP Nurse Practitioner NPI 1710352349
- Jason Van Sickle, D.C. Chiropractor NPI 1386981900
Specialties
-
Podiatrist PrimaryA podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 806462800 |
Practice context
Multi-provider organization. 4 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.