Madison Co Memorial Hospital
Organization Active NPI Obstetrics & Gynecology Physician · Rexburg, ID
NPI 1073154266 · NPPES record last updated Mar 5, 2026
Key facts
- NPI
- 1073154266
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- MADISON CO MEMORIAL HOSPITAL
- Practice address
- 37 S 2ND E
Rexburg, ID 83440-1906 - Phone
- (208) 356-0234
- NPI assigned
- Sep 30, 2019
- Organization subpart
- Yes
- Parent organization (as reported)
- MADISON CO MEMORIAL HOSPITAL
Authorized official
- Name
- Rachel Gonzales, DM, RN, RODP
- Title
- Chief Executive Officer
- Phone
- (208) 359-6900
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 1
-
Marshall H Merrell, O.D.
Other NPIs on the same Medicare enrollment 7
Related certifications (CCN) 2
Practitioners 21
-
Zachery M Brunson, PA-C
-
Jack O. Clark, M.D.
-
Zackery J Cleverley, PA-C
-
Hayley Brooke Grover, FNP-C
-
Michael J Larson, MD
-
Angela Peterson, FNP-C
-
Linda R Webster, NP
-
McKay Rees Tingey, PA-C
-
Brian Paul Beesley, M.D.
-
Erin Joanne Benson, NP-C
-
Melissa Marie Black, FNP-C
-
Scott Russell Hardy, D.O.
-
Marie Horne, CNM
-
Michael M Packer, M.D.
-
Travis J Weiszhaar, P.A.-C.
-
Suzanne Wilbrecht, MSN
Affiliated clinicians 180
-
David Paul Adams, FNP-C
-
William D Adams, DO
-
Travis Lee Allen, PA-C
-
Matthew Hardy Allred, D.O.
-
Michael Anderson, D.O.
-
Bryce L Arnold, D.O.
-
Eric E. Barton, DPM
-
Jed Terrell Bartschi, PA-C
-
Brian Paul Beesley, M.D.
-
Clint E Behrend, M.D.
-
Erin Joanne Benson, NP-C
-
Colby Bingham, M.D.
-
Mel Bingham, PA-C
-
Melissa Marie Black, FNP-C
-
Adam Robert Blakeman, PA-C
-
Douglas U. Blank, MD
-
Richard Alan Blatter, D.O.
-
Andrew Logan Brower, PA-C
-
John D Chambers Jr., M.D.
-
Brian Wade Christensen, M.D.
-
Jack O. Clark, M.D.
-
Zackery J Cleverley, PA-C
Medicare Care Compare: Hospital
- Listed as
- Madison Memorial Hospital
- Type
- Acute Care Hospitals
- Ownership
- Government - Local
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID
Hospital certification: CCN 130025
- Legal name
- MADISON CO MEMORIAL HOSPITAL
- Doing business as
- MADISON MEMORIAL HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 1, 1966
- Last certification
- Jun 28, 2018
- Beds
- 81
- Ownership / control type
- Local
- Organization structure
- Other · Non-profit
- Enrollment address
- 450 E Main St
Rexburg, ID 83440-2048 - Hospital subgroups
- General, Acute care
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Marshall Merrell |
Other | Apr 13, 2006 | |
| Holly Forbush |
Other | Jan 22, 2015 | |
| Rachel Gonzales |
Corporate Officer |
Jun 25, 2008 | |
| Jerry Rigby |
Other | Apr 18, 2011 | |
| Joseph Troy Christensen |
Corporate Officer |
Aug 1, 2013 | |
| Maurie Barton |
Other | Apr 18, 2011 | |
| Ken Burt |
Other | Jun 30, 1999 | |
| Scott Dixon |
Other | Sep 4, 2012 | |
| Taunia Berrett |
W-2 Managing Employee | Jan 1, 2011 | |
| Neil Erickson |
Other | Apr 18, 2011 | |
| Dan Kettle |
Other | Jan 24, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040505000664 | ID | Part B Supplier - Clinic/Group Practice | 8123016367 |
Receives reassigned benefits from 45 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rexburg, ID; Rigby, ID |
| O20050707000644 | ID | Part a Provider - Hospital | 8123016367 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Rexburg, ID |
National Provider Directory
- Part of
- Madison Co Memorial Hosp
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | Yes | ||
| Pediatrics Physician |
208000000X |
Addresses
Primary practice location
37 S 2ND E
Rexburg, ID 83440-1906
Mailing address
37 S 2ND E
Rexburg, ID 83440-1906
Phone (208) 656-8454
Other practice location 1
477 Pleasant Country Ln
Rigby, ID 83442-5278
Phone (208) 356-0234
Other names
- Seasons Medical By Madison Memorial
Other providers in Rexburg, ID
- Nicole Lybbert
- Kirk Lynn Mace
- Bree Anne Mackenzie
- Madison Anesthesia Services PA
- Madison Clinic Optometry, P.C.
- Madison Co Memorial Hospital
- Madison Co Memorial Hospital
- Madison Co Memorial Hospital
- Madison Co Memorial Hospital
- Madison Co Memorial Hospital
All providers in Rexburg, ID · Obstetrics & Gynecology Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.