Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tanner Blaylock Bodily

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1356957039

Tanner Blaylock Bodily is a Physician Assistant in Idaho Falls, Idaho. Qualified in 2021, 5 years ago. Practices with Root Cause Integrative Medicine LLC, a 5-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Idaho.

Years since qualifying
5
Licensed in
ID
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

3360 Washington Pkwy Ste 1
Idaho Falls, ID 83404-8333
Phone: (208) 524-3416
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (ID)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1356957039
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 18, 2020
Last updated in NPPESJuly 30, 2026
Certification dateJuly 30, 2026
Mailing address3360 Washington Pkwy Ste 1, Idaho Falls, ID 83404-7592

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Root Cause Integrative Medicine Llc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Idaho Falls