{"npi":"1629145685","type":"NPI-2","status":"active","name":{"display":"Idaho Eye Center PA","other":[],"organization_name":"IDAHO EYE CENTER PA","authorised_official":"Bradley Gardner"},"specialty":{"primary_taxonomy":"261QA1903X","primary_taxonomy_description":"Ambulatory Surgical Clinic/Center","slug":"ambulatory-surgical-clinic-center","schema_org_specialty":null,"all":[{"code":"261QA1903X","description":"Ambulatory Surgical Clinic/Center","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2025 E 17TH ST","city":"IDAHO FALLS","state":"ID","postal_code":"83404","country_code":"US","phone":"2085242025","fax":"2085291924"},{"purpose":"MAILING","street_1":"2025 E 17TH ST","city":"IDAHO FALLS","state":"ID","postal_code":"83404","country_code":"US","phone":"2085242025","fax":"2085291924"}],"license":null,"identifiers":[{"type_code":"01","label":"Other","value":"490000614","state":"ID","issuer":"RAILROAD MEDICARE"},{"type_code":"01","label":"Other","value":"480000614","state":"ID","issuer":"RAILROAD MEDICARE"},{"type_code":"01","label":"Other","value":"00984","state":"ID","issuer":"BLUE CROSS"},{"type_code":"05","label":"Medicaid","value":"002562201","state":"ID","issuer":null},{"type_code":"05","label":"Medicaid","value":"002565200","state":"ID","issuer":null},{"type_code":"01","label":"Other","value":"105947500","state":"ID","issuer":"WYOMING MEDICAID"},{"type_code":"01","label":"Other","value":"5207","state":"ID","issuer":"BLUE CROSS"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20071114000130","type_code":"12-49","type_desc":"PART B SUPPLIER - AMBULATORY SURGICAL CENTER","state":"ID","pac_id":"1557358025"},{"enrlmt_id":"O20221007001696","type_code":"12-49","type_desc":"PART B SUPPLIER - AMBULATORY SURGICAL CENTER","state":"ID","pac_id":"1557358025"},{"enrlmt_id":"O20251003003072","type_code":"12-49","type_desc":"PART B SUPPLIER - AMBULATORY SURGICAL CENTER","state":"ID","pac_id":"1557358025"},{"enrlmt_id":"O20251003003198","type_code":"12-49","type_desc":"PART B SUPPLIER - AMBULATORY SURGICAL CENTER","state":"ID","pac_id":"1557358025"}]},"enumeration_date":"2006-11-28","last_updated":"2008-08-12","_meta":{"source":"NPPES","snapshot_date":"2008-08-12","doc_url":"https://findmynpi.com/api"}}