Tony C Roisum MD PA
NPI 1124115944 · Family Medicine Physician · Idaho Falls, ID
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Tony C Roisum MD PA is a Family Medicine Physician organization in Idaho Falls, ID (NPI 1124115944).
Provider details
- NPI number
- 1124115944
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jacqueline Kelsey, Office Manager(208) 524-3416
- License
- M7389 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Idaho Falls Family & Sports Medicine
Registry dates
- Enumerated
- 2006-10-05
- Last updated
- 2026-01-16
- Certified
- 2026-01-16
Frequently asked questions
- What is Tony C Roisum MD PA's NPI number?
- Tony C Roisum MD PA's National Provider Identifier (NPI) is 1124115944, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Tony C Roisum MD PA?
- Tony C Roisum MD PA is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Tony C Roisum MD PA located?
- Tony C Roisum MD PA's practice location on file with NPPES is 3360 Washington Pkwy, Idaho Falls, ID 83404-8333.
- What is Tony C Roisum MD PA's phone number?
- The practice phone number listed in the NPPES registry for Tony C Roisum MD PA is (208) 524-3416.
- Does Tony C Roisum MD PA accept Medicare?
- Tony C Roisum MD PA is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Tony C Roisum MD PA?
- The authorized official listed on Tony C Roisum MD PA's NPPES record is Jacqueline Kelsey, Office Manager. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Tony C Roisum MD PA's NPI active?
- Yes — Tony C Roisum MD PA's NPI (1124115944) is active in the NPPES registry as of the last update on 2026-01-16.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.