NPIMap

Individual provider Active NPI

Melissa Brianne McClenahan, PA-C

  • Physician Assistant
  • Meridian, ID
National Provider Identifier
1053695676
Registry record updated Feb 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA935 Issued in ID
Practice address
2855 E Magic View Dr
Meridian, ID 83642-6245
Phone
(208) 639-4900
Fax
(208) 639-4901
NPI assigned
Sep 30, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA935 ID Primary

Addresses

Primary practice location

2855 E Magic View Dr
Meridian, ID 83642-6245

Mailing address

2855 E Magic View Dr
Meridian, ID 83642-6245
Phone (208) 639-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111221000643 ID Practitioner - Physician Assistant 0749456747 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bridgeway Health Services LLCGroup PAC ID 0244462745, 10 clinicians
Idaho Urologic Institute PAGroup PAC ID 9537199039, 20 clinicians

Practice addresses (Care Compare)

1032 S Bridgeway PL
Suite 110
Eagle, ID 83616-6099
Phone (208) 246-0123

222 N 2ND St
Suite 115
Boise, ID 83702-6129
Phone (208) 639-4900

2855 E Magic View Dr
Meridian, ID 83642-6245
Phone (208) 639-4900

6195 E Hunt Ave
Nampa, ID 83687-8317
Phone (208) 639-4900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.29 of 100Reported as group
Quality
52.53
Promoting interoperability
100
Improvement activities
40
Cost
75.1

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA935IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Surgical, LLC PastSince May 1, 2019 Accepting new patients
Bridgeway Health Services, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mmcclenahan1563181@direct.trinity-health.org

Organizations & group practices 4

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613952000000",
    "number": "1053695676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900",
            "fax_number": "208-639-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLENAHAN",
        "first_name": "MELISSA",
        "middle_name": "BRIANNE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-30",
        "last_updated": "2021-02-22",
        "certification_date": "2021-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.