NPI age
19 years
Enumerated 2007-01-25
● Active
Type 1 · Individual
MR. Brett Gerald Bagley, P.A. - CERTIFIED
Bagley is 1 of 11 physician assistant providers in Rexburg and 1 of 387 in Idaho.
Primary specialty
Physician Assistant
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2018-06-26
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 387 active physician assistant providers in Idaho.
NPI age
19 years
↑ 4 yr above median (15 yr)
State licenses
1 state
16% of peers hold multiple states
Subspecialties
0
30% of peers hold subspecialties
NPI lifetime · 2007 → 2026
2007-01Enumerated in NPPES
2007
2026
Where they practice
Practice location
556 Trejo St, Suite B
Rexburg, ID 83440
Mailing address
534 Trejo St Ste 400
Rexburg, ID 834405405
Specialties
-
Physician Assistant PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 805069800 | |
| 01 (ID) | 201139500 | TAX IDENTIFICATION |
Practice context
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.