Individual provider Active NPI

Pamela A Martin, PT ATC

  • Physical Therapist
  • Meridian, ID
National Provider Identifier
1154380293
Registry record updated Jun 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT1850 Issued in ID
Practice address
1618 Millenium Way
Suite 210
Meridian, ID 83642-6439
Phone
(208) 884-4647
Fax
(208) 884-8984
NPI assigned
Mar 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT1850 ID Primary

Addresses

Primary practice location

1618 Millenium Way
Suite 210
Meridian, ID 83642-6439

Mailing address

1673 W Shoreline Dr
Suite 230
Boise, ID 83702-6750
Phone (208) 343-4700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090721000778 ID Practitioner - Physical Therapist in Private Practice 5193764819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Foothills Physical Therapy PAGroup PAC ID 9931010014, 28 clinicians

Practice addresses (Care Compare)

645 E State St
Suite 101
Eagle, ID 83616-5915
Phone (208) 939-9594

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT1850IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Foothills Physical Therapy PA CurrentSince Jul 15, 2009 Accepting new patients
Elmhurst Orthopaedics, SC Past Accepting new patients

Locations

1673 W Shoreline Dr
Ste 230
Boise, ID 83702
Phone (208) 343-4700

645 E State St
Ste 101
Eagle, ID 83616
Phone (208) 939-9594

1618 S Millenium Way
Ste 210
Meridian, ID 83642
Phone (208) 884-4647

1256 S Rackham Way
Ste 110
Meridian, ID 83642
Phone (208) 939-9594

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245369600000",
    "number": "1154380293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1673 W SHORELINE DR",
            "address_2": "SUITE 230",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026750",
            "telephone_number": "208-343-4700",
            "fax_number": "208-343-4706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1618 MILLENIUM WAY",
            "address_2": "SUITE 210",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426439",
            "telephone_number": "208-884-4647",
            "fax_number": "208-884-8984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "PAMELA",
        "middle_name": "A",
        "credential": "PT ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-18",
        "last_updated": "2009-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT1850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; 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.