Michael R Dibenedetto MD PLLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

M10671 Issued in ID

Legal business name

MICHAEL R DIBENEDETTO MD PLLC

Practice address

30544 Highway 200
Suite 102
Ponderay, ID 83852-5005

Phone

(208) 263-5900

Fax

(208) 263-1319

NPI assigned

Apr 29, 2009

Organization subpart

Yes

Parent organization

MICHAEL R DIBENEDETTO MD PLLCAs reported in NPPES

Name

Wendy S Brosnahan

Title

Office Manager

Phone

(208) 263-5900

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Michael R Dibenedetto MD PLLC

  • Orthopaedic Surgery Physician
  • Ponderay, ID
  • NPI 1083809727
  NPPES parent name

Organizations that report the same tax identification number in the National Provider Directory.

• Michael R Dibenedetto MD PLLC

  • Orthopaedic Surgery Physician
  • Ponderay, ID
  • NPI 1083809727
  NPD tax ID

Tax ID family

Michael R Dibenedetto MD PLLC (2 organizations share this tax ID)

Part of

Michael R Dibenedetto MD PLLC

• Seasons Plastic & Reconstructive Surgery Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 21, 2009.

{
    "created_epoch": "1240963200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1073757464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200",
            "address_2": "SUITE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525005",
            "telephone_number": "208-263-5900",
            "fax_number": "208-263-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200",
            "address_2": "SUITE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525005",
            "telephone_number": "208-263-5900",
            "fax_number": "208-263-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R DIBENEDETTO MD PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MICHAEL R DIBENEDETTO MD PLLC",
        "enumeration_date": "2009-04-29",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "BROSNAHAN",
        "authorized_official_first_name": "WENDY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-263-5900"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "ID",
            "license": "M10671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "DG3627",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8N834",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seasons Plastic & Reconstructive Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Benjamin Lusk, DPT
• Adelaida Mahler, LMT
• Kim C Marley
• Matthew Wittwer Chiropractic, P.L.L.C.
• Amy McGrath, PHARMACIST
• Michael R Dibenedetto MD PLLC
• Nicholas G Miller, D.M.D
• Amber C Moir-Brow, LCSW, ACADC
• Joshua Robert Moore, DC
• Nora Morrison, LMT

• All providers in Ponderay, ID
• Plastic and Reconstructive Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.