Michael Clyde Graham, P.A.
Individual provider Active NPI Physician Assistant · Potlatch, ID
NPI 1205901477 · NPPES record last updated Jun 20, 2012
Key facts
- NPI
- 1205901477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA594 (ID)
- Practice address
- 225 6TH St
Potlatch, ID 83855-5002 - Phone
- (208) 883-2220
- NPI assigned
- Nov 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Kootenai Urgent Care LLC
Practice addresses (Care Compare)
700 W Ironwood Dr
Suite 120E
Coeur D Alene, ID 83814-2656
Phone (208) 625-3640
Hospital & facility affiliations
- Kootenai Health
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.65 of 100
- Quality
- 89.26
- Promoting interoperability
- 69.9
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060209000488 | ID | Practitioner - Physician Assistant | 3971578196 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA594 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kootenai Urgent Care LLC | Physician Assistant | Current |
Accepting new patients |
| Kootenai Urgent Care LLC | Physician Assistant | Current |
Accepting new patients |
| Kootenai Health, Inc. | Current |
Accepting new patients | |
| Kootenai Health, Inc. | Physician Assistant | Past | Accepting new patients |
| Renown Urgent Care LLC | Physician Assistant | Past | Accepting new patients |
| Ozarks Medical Center | Past | Accepting new patients | |
| Kootenai Health, Inc. | Past | Accepting new patients |
Locations
700 W Ironwood Dr
Ste 120E
Coeur D Alene, ID 83814
Phone (208) 625-3640
700 W Ironwood Dr
Ste 120
Coeur D Alene, ID 83814
Phone (208) 625-3640
700 W Ironwood Dr
Ste 220E
Coeur D Alene, ID 83814
Interoperability endpoints
- mgraham610056@direct.multicare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA594 | ID | Yes |
Addresses
Primary practice location
225 6TH St
Potlatch, ID 83855-5002
Mailing address
225 6TH St
Potlatch, ID 83855-5002
Phone (208) 883-2220
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807364300 | Medicaid | ID |
Other providers in Potlatch, ID
- Charlotte S Ainge
- Amanda Black
- Nicholas John Browneller
- County of Latah 285 School District
- Dan Lawson DDS, PC
- Gritman Medical Center Inc
- Michael S. Hess
- Lindsay Ranaye Lisher
- Northwest Clinical Services
- Northwest Pharmacy Services Inc
All providers in Potlatch, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.