Clinton Mallari, MD

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

M6287 Issued in ID

Practice address

115 W Main St
Suite 102
Boise, ID 83702-7302

Phone

(208) 342-4700

Fax

(208) 342-4710

NPI assigned

Jul 27, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Interventional Pain Management

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• FHIR API: https://api.platform.athenahealth.com/11756/brand/1/csg/1/fhir/r4
• Direct secure messaging: clinton.mallari.1@11756.direct.athenahealth.com

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.

• Center for Pain Care P a

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Boise, ID
  • NPI 1023024684
  Medicare reassignment NPD Authorized official
• Professional Rehabilitation Hospital LLC

  • Long Term Care Hospital
  • Vidalia, LA
  • NPI 1518929926
  NPD (past)
• Promise Hospital of Baton Rouge, Inc

  • Long Term Care Hospital
  • Gonzales, LA
  • NPI 1194969386
  NPD (past)

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

• St Lukes Regional Medical Center

  • Ambulance
  • Boise, ID
  • NPI 1518115195

  Hospital

  Care Compare affiliation
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  Care Compare affiliation

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154345585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W MAIN ST",
            "address_2": "SUITE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027302",
            "telephone_number": "208-342-4700",
            "fax_number": "208-342-4710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W MAIN ST",
            "address_2": "SUITE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027302",
            "telephone_number": "208-342-4700",
            "fax_number": "208-342-4710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLARI",
        "first_name": "CLINTON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "ID",
            "license": "M6287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Soraya Maleki, LAC
• Neha Malhotra, MD
• Emily Malinowski, CTRS
• Martha E Malkasian, MA, CCC SLP
• Mallard Family Dental Center, PLLC
• Dion Janet Mallea, RPH
• Amber Mallet-Wrout, FNP-C
• Claire E Mallicoat
• Mark A Mallory, M.D.
• Natalie Ann Malm, PHARMD

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Boise, ID
• Providers in Boise, ID by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.