DR. SHAUN STEPHEN SUMMERILL (NPI# 1497807044) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497807044 |
| Entity Type | Individual |
| Full Name | DR. SHAUN STEPHEN SUMMERILL |
| Credential | M.D. |
| Practice Address |
1151 Hospital Way Bldg F Pocatello ID 83201 |
| Mailing Address |
1151 Hospital Way Bldg. F Pocatello ID 83201 |
| Practice Telephone | 2082321443 |
| Practice Fax Number | 2082393434 |
| Mailing Telephone | 2082321443 |
| Mailing Fax Number | 2082393434 |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-09-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | M-11365 | ID | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 49001 | WI | Allopathic & Osteopathic Physicians |
| N | 2080P0204X |
Pediatrics Specialization: Pediatric Emergency Medicine |
49001 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 808342900 | 05 |
| Street Address |
1151 HOSPITAL WAY BLDG F |
| City | POCATELLO |
| State | ID |
| Zip Code | 83201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437151446 | Matthew Ayers Murdoch | Pediatrics | 1151 Hospital Way, Building F, Pocatello, ID 83201-5091 | 2005-08-10 |
| 1093132458 | Haiden L Siepert | Specialist/Technologist | 1151 Hospital Way, Pocatello, ID 83201-5091 | 2014-03-24 |
| 1912223959 | Cindy Elizabeth Parsons | Pediatrics | 1151 Hospital Way, Bldg F, Pocatello, ID 83201 | 2010-04-15 |
| 1992950802 | Laura M Duty | Pediatrics | 1151 Hospital Way, Bldg. F, Pocatello, ID 83201 | 2008-11-19 |
| 1194996868 | Jessica Lusk | Social Worker | 1151 Hospital Way, Pocatello, ID 83201-5091 | 2008-03-20 |
| 1730367517 | Brian C Fulks | Pediatrics | 1151 Hospital Way, Bldg F, Pocatello, ID 83201 | 2008-02-04 |
| 1033396049 | Jamie Kae Cobbley | Specialist | 1151 Hospital Way, Pocatello, ID 83201-5091 | 2008-01-22 |
| 1205025673 | Bmh Inc | Clinic/Center | 1151 Hospital Way, Pocatello, ID 83201-5091 | 2007-10-22 |
| 1649474719 | Jonathan D Godfrey | Internal Medicine | 1151 Hospital Way, Building A, Pocatello, ID 83201-5091 | 2007-06-13 |
| 1477690899 | Paula Brutz Phelps | Physician Assistant | 1151 Hospital Way, Suite D, Suite 201, Pocatello, ID 83201-5091 | 2007-02-01 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235765330 | Timothy Palmer | Social Worker | 400 S 11th Ave, Ste 204, Pocatello, ID 83201 | 2020-03-20 |
| 1225687759 | Hanna Percy | Nurse Practitioner | 1151 Hospital Way Ste 201, Pocatello, ID 83201 | 2019-09-07 |
| 1659935195 | Carol Jane Dillon | Counselor | 707 North 7th Avenue, Suite D, Pocatello, ID 83201 | 2019-04-30 |
| 1154801595 | Mv Pocatello Ent, LLC | Otolaryngology | 333 N 18th Ave Ste B3, Pocatello, ID 83201 | 2018-08-15 |
| 1306344346 | Ruth Anne Patton | Social Worker | 850 E Young St, Pocatello, ID 83201 | 2018-01-24 |
| 1598289274 | Lucas Alexander Bryan | Specialist/Technologist | 1535 E Terry St, Pocatello, ID 83201 | 2017-08-03 |
| 1205365632 | Geno Alan Giovanini | Denturist | 115 S. 15th Ave. Ste. D, Pocatello, ID 83201 | 2017-06-08 |
| 1518415942 | Kelli Fries-geslin | Nurse Practitioner | 500 South 11 Ave Suite 400, Pocatello, ID 83201 | 2016-09-14 |
| 1346797842 | Shailyn Jenkins | Specialist/Technologist | 665 Warren Ave., Pocatello, ID 83201 | 2016-09-01 |
| 1992258149 | Christopher Jared White | Social Worker | 300 N 7th Ave, Pocatello, ID 83201 | 2016-07-24 |
| Find all providers in zip 83201 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700149887 | Cristina Leon | Pediatrics | 9927 W Gibson Jack Rd, Pocatello, ID 83204-4964 | 2012-06-22 |
| 1447316799 | Gregory Daniel Kostur | Pediatrics | 500 S 11th Ave Ste 204, Pocatello, ID 83201-4878 | 2006-12-29 |
| 1609844471 | Matthew A Stelzer | Pediatrics | 1151 Hospital Way Bldg F, Pocatello, ID 83201-5091 | 2006-03-09 |
| 1932527827 | David J Larsen | Pediatrics | 1151 Hospital Way Bldg F, Pocatello, ID 83201-5091 | 2014-03-29 |
| 1346507845 | Alison Marie Mcinturff | Pediatrics | 1151 Hospital Way Bldg F, Pocatello, ID 83201 | 2012-04-20 |
| 1992950802 | Laura M Duty | Pediatrics | 1151 Hospital Way, Bldg. F, Pocatello, ID 83201 | 2008-11-19 |
| 1730367517 | Brian C Fulks | Pediatrics | 1151 Hospital Way, Bldg F, Pocatello, ID 83201 | 2008-02-04 |
| 1366508954 | Yost and Yost Pediatrics | Pediatrics | 950 Hospital Way, Suite A, Pocatello, ID 83201-2789 | 2006-12-28 |
| 1700898822 | Pocatello Children & Adolescent Clinic | Pediatrics | 1151 Hospital Way Bldg F, Pocatello, ID 83201-5091 | 2006-08-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780146316 | Frontier Pediatric Partners, Pllc | Pediatrics | 1502 Locust Street N #700, Twin Falls, ID 83301 | 2019-04-02 |
| 1316468002 | Shannon Marie Seckel | Pediatrics | 420 N 2nd Ave Ste 100, Sandpoint, ID 83864-1552 | 2017-07-03 |
| 1669918769 | University of Utah Pediatric Services | Pediatrics | 1645 Pancheri Dr, Idaho Falls, ID 83402-3169 | 2017-01-12 |
| 1366836843 | Andrew Nolan Monson | Pediatrics | 775 Pole Line Rd W Ste 111, Twin Falls, ID 83301-5819 | 2015-03-23 |
| 1699172262 | Boundary Regional Community Health Center, Inc. | Pediatrics | 6833 El Paso St, Bonners Ferry, ID 83805-8569 | 2014-11-26 |
| 1801216940 | Seth Branahl | Pediatrics | 520 S Eagle Rd Ste 2209, Meridian, ID 83642-6354 | 2014-04-16 |
| 1437577483 | Kaitlin Burke | Pediatrics | 100 E Idaho St Ste 401, Boise, ID 83712-6267 | 2014-04-06 |
| 1063775286 | Abram Collard | Pediatrics | 1236 Bond Ave Ste B, Rexburg, ID 83440-3503 | 2012-06-21 |
| 1205104593 | Pullman Regional Hospital Clinic Network LLC | Pediatrics | 1420 S Blaine St Ste 5, Moscow, ID 83843-3973 | 2011-12-01 |
| 1629370861 | Hafid Mantilla | Pediatrics | 3217 W Bavaria, Eagle, ID 83616 | 2010-11-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.