NPI age
18 years
Enumerated 2008-05-16
● Active Type 2 · Organization
Idaho Falls Surgical Center
Idaho Falls Surgical Center is 1 of 575 nurse anesthetist, certified registered organizations in Idaho.
Primary specialty
Nurse Anesthetist, Certified Registered
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Petersen
President
Last NPPES update
2008-05-16
Source: monthly bulk 2026-05
How this organization compares
Across 575 active nurse anesthetist, certified registered providers in Idaho.
NPI age
18 years
↑ 3 yr above median
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2008 → 2026
2008-05Enumerated in NPPES
2008
2026
Where they practice
Primary practice location
1945 E 17th St
Idaho Falls, ID 834046429
Mailing address
Po Box 52180
Idaho Falls, ID 834052180
Authorized official
Mark L. Petersen, MD
President
📞 2085291945
Individual providers at this organization
1 individual provider on file at this primary practice address.
- Jon Champlin, CRNA Nurse Anesthetist, Certified Registered NPI 1386722429
Specialties
-
Nurse Anesthetist, Certified Registered Primary(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | DB0412 | RAILROAD MEDICARE |
| 05 (ID) | 806687900 |
Practice context
Multi-provider organization. 1 individual provider 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.