NPIMap

Individual provider Active NPI

Michael A Kaylor, M.D.

  • Family Medicine Physician
  • Eagle, ID
National Provider Identifier
1104878610
Registry record updated Oct 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M9661 Issued in ID
Practice address
435 S Eagle Rd
Eagle, ID 83616-6067
Phone
(208) 939-8200
Fax
(208) 939-8222
NPI assigned
May 16, 2006
Last updated
Oct 29, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M9661 ID Primary

Addresses

Primary practice location

435 S Eagle Rd
Eagle, ID 83616-6067

Mailing address

190 E Bannock St
Boise, ID 83712
Phone (208) 375-4955

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
I20060907000080 ID Practitioner - Family Practice 1355345216 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Momentum Medical Group of Idaho LLCGroup PAC ID 2668824608, 8 clinicians

Practice addresses (Care Compare)

1281 E Iron Eagle Dr
Eagle, ID 83616-6599
Phone (208) 855-0880

8950 W Emerald St
Suite 195
Boise, ID 83704-8296
Phone (208) 999-3034

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M9661IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Momentum Medical Group of Idaho LLC Family Medicine CurrentSince Aug 1, 2025 Accepting new patients
Kaylor Family Medicine PLLC CurrentSince May 23, 2019 Accepting new patients
Sage Healthcare PLLC Family Medicine CurrentSince Jun 27, 2010 Accepting new patients

Locations

413 N Allumbaugh St
Ste 101
Boise, ID 83704
Phone (208) 323-1125

8854 W Emerald St
Ste 140
Boise, ID 83704
Phone (208) 321-4790

8950 W Emerald St
Ste 195
Boise, ID 83704
Phone (208) 376-7313

2536 N Stokesberry Pl
Meridian, ID 83646
Phone (208) 855-0880

3080 E Gentry Way
Ste 100
Meridian, ID 83642
Phone (208) 810-2318

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IEHCDD

Organizations & group practices 3

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

Hospital & facility affiliations 9

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540771200000",
    "number": "1104878610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83712",
            "telephone_number": "208-375-4955",
            "fax_number": "208-375-5568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 S EAGLE RD",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166067",
            "telephone_number": "208-939-8200",
            "fax_number": "208-939-8222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAYLOR",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2018-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M9661",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.