NPIMap

Organization Active NPI

Michael R Dibenedetto MD PLLC

Doing business as North Idaho Cardiac Rehabilitation

  • Orthopaedic Surgery Physician
  • Ponderay, ID
National Provider Identifier
1083809727
Registry record updated Jun 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
MICHAEL R DIBENEDETTO MD PLLC
Doing business as
North Idaho Cardiac Rehabilitation
North Idaho Orthopedics & Sports Medicine
Woodlands Family Medicine
Practice address
30544 Hwy 200
Ste 102
Ponderay, ID 83852
Phone
(208) 265-9836
Fax
(208) 263-7249
NPI assigned
Sep 6, 2007
Last updated
Jun 30, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2026

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

Authorized official

Name
Kirsten Eveland
Title
Practice Manager
Phone
(208) 265-9817

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiac Rehabilitation Clinic/Center 261QR0404X
Orthopaedic Surgery Physician 207X00000X Primary

Addresses

Primary practice location

30544 Hwy 200
Ste 102
Ponderay, ID 83852

Mailing address

30544 Highway 200 Ste 102
Ponderay, ID 83852-5005
Phone (208) 265-9817

Other identifiers 4

IdentifierTypeStateIssuer
806452000MedicaidID
DG3627OtherIDPALMETTO GBA RAILROAD MED
000010140056OtherIDREGENCE BLUE SHIELD
8N259OtherIDBLUE CROSS

Other names 3

  • North Idaho Cardiac Rehabilitation Doing business as
  • North Idaho Orthopedics & Sports Medicine Doing business as
  • Woodlands Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071009000187 ID Part B Supplier - Clinic/Group Practice 0840385670 Receives reassigned benefits from 14 practitioners
Practice locations: Ponderay, ID; Sandpoint, ID
O20100930060806 ID DME Supplier - Physician - General Practice 0840385670 Practice locations: Ponderay, ID
O20210113002323 ID Part B Supplier - Intensive Cardiac Rehabilitation 0840385670 Receives reassigned benefits from 2 practitioners
Practice locations: Ponderay, ID

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
13D1050770Woodlands Family Medicine30544 Hwy 200 #102, Ponderay, ID 83852Provider-performed microscopyFeb 12, 2028

National Provider Directory

National Provider Directory
Tax ID family
Michael R Dibenedetto MD PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

30544 Highway 200
Ste 101
Ponderay, ID 83852
Phone (208) 263-6300

30544 Highway 200
Ste 103
Ponderay, ID 83852
Phone (208) 946-5110

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782777600000",
    "number": "1083809727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200 STE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525005",
            "telephone_number": "208-265-9817",
            "fax_number": "208-265-4533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30544 HWY 200",
            "address_2": "STE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "83852",
            "telephone_number": "208-265-9836",
            "fax_number": "208-263-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL R DIBENEDETTO MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-06",
        "last_updated": "2026-06-30",
        "certification_date": "2026-06-30",
        "status": "A",
        "authorized_official_last_name": "EVELAND",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "208-265-9817"
    },
    "taxonomies": [
        {
            "code": "261QR0404X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Cardiac Facilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806452000",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA RAILROAD MED",
            "identifier": "DG3627",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010140056",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8N259",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Idaho Cardiac Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Idaho Orthopedics & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "North Idaho Orthopedics & Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Woodlands Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ponderay, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.