Kelly Meacham, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1290 Issued in ID

Practice address

3389 Merlin Dr
Idaho Falls, ID 83404-7405

Phone

(208) 552-9831

NPI assigned

Oct 15, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362
  Medicare reassignment NPD
• Emergency Physicians Integrated Care, LLC

  • Emergency Medicine Physician
  • Salt Lake City, UT
  • NPI 1578598199

  ID

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1444867200000",
    "number": "1023489085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3389 MERLIN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3389 MERLIN DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047405",
            "telephone_number": "208-552-9831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEACHAM",
        "first_name": "KELLY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-10-15",
        "last_updated": "2015-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly Marie McMurtrey, LCSW
• Connor McNairy
• Paige McOmber, LCSW
• Kevin McOmie
• Malinda McRea, FNP-C
• Meadowbrook Counseling of Idaho, LLC (Meadowbrook Counseling of Idaho)
• Haylee Mears
• Andrea M Mecham
• Brian Butler Mecham, LCSW
• Hannah Marie Lynn Mecham, MOTR/L

• Physician Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.