Active NPI
Michael Anderson, D.O.
- Emergency Medical Services (Emergency Medicine) Physician
- Rexburg, ID
National Provider Identifier
1194019406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medical Services (Emergency Medicine) Physician
- License
- O-0885
- Practice address
- 450 E Main St
Rexburg, ID 83440-2048 - Phone
- (208) 356-3691
- NPI assigned
- Jun 3, 2011
- Last updated
- Apr 2, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medical Services (Emergency Medicine) Physician | 207PE0004X | O-0885 | ID | Primary |
| Family Medicine Physician | 207Q00000X | ED0179A | WV |
Addresses
Primary practice location
450 E Main St
Rexburg, ID 83440-2048
Mailing address
450 E Main St
Rexburg, ID 83440-2048
Phone (208) 356-3691
Other practice location 1
202 Maplewood Ave
Ronceverte, WV 24970-1334
Phone (304) 647-6529
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346643038 | Medicaid | ID |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Emergency Medicine
- Education
- West Virginia School of Osteopathic Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
450 E Main St
Reburg, ID 83440-2048
Phone (208) 359-6516
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.03 of 100
- Quality
- 91.16
- Promoting interoperability
- 97
- Improvement activities
- 40
- Cost
- 71.43
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2598 | WV | MD | Mental Health Counselor |
| ED0179A | WV | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| WT University Medical Associates Inc | Family Medicine | Current | Accepting new patients |
| Madison Memorial Hospital | Current | Accepting new patients |
Locations
450 E Main St
Rexburg, ID 83440
Phone (208) 356-3691
294 Summar Dr
Jackson, TN 38301
Phone (731) 423-1932
620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/d61ab3e4-55bb-4859-99e6-22c413b48f2a/
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Madison Clinic Physicians
- Multi-Specialty Clinic/Center
- Rexburg, ID
- NPI 1346643038
-
dba West Tennessee Medical Group UT Medicine
- Family Medicine Physician
- Jackson, TN
- NPI 1023572344
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Seasons Medical By Madison Memorial
- Obstetrics & Gynecology Physician
- Rexburg, ID
- NPI 1073154266
Hospital
-
- General Acute Care Hospital
- Rexburg, ID
- NPI 1992747570
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1669462362
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585785600000",
"number": "1194019406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "450 E MAIN ST",
"city": "REXBURG",
"state": "ID",
"postal_code": "834402048",
"telephone_number": "208-356-3691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 E MAIN ST",
"city": "REXBURG",
"state": "ID",
"postal_code": "834402048",
"telephone_number": "208-356-3691"
}
],
"practiceLocations": [
{
"address_1": "202 Maplewood Ave",
"address_purpose": "LOCATION",
"city": "Ronceverte",
"state": "WV",
"postal_code": "249701334",
"country_code": "US",
"telephone_number": "304-647-6529",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ANDERSON",
"first_name": "MICHAEL",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-03",
"last_updated": "2020-04-02",
"certification_date": "2020-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "207PE0004X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Emergency Medical Services",
"state": "ID",
"license": "O-0885",
"primary": true
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WV",
"license": "ED0179A",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1346643038",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; 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.