Michael Clyde Graham, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA594 Issued in ID

Practice address

225 6TH St
Potlatch, ID 83855-5002

Phone

(208) 883-2220

NPI assigned

Nov 22, 2006

Last updated

Jun 20, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kootenai Urgent Care LLCGroup PAC ID 1052441946, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049

Merit-based Incentive Payment System (MIPS)

Final score

86.65 of 100Reported as apm

Quality

89.26

Promoting interoperability

69.9

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mgraham610056@direct.multicare.org

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.

• Kootenai Urgent Care LLC

  • Family Medicine Physician
  • Coeur d'Alene, ID
  • NPI 1821312356

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Kootenai Health, Inc.

  • Psychiatry Physician
  • Coeur d'Alene, ID
  • NPI 1174661151
  Medicare reassignment NPD (past)
• Kootenai Health, Inc.

  dba Kootenai Health Pharmacy

  • Community/Retail Pharmacy
  • Hayden, ID
  • NPI 1235986290
  NPD
• Kootenai Health, Inc.

  dba Kootenai Medical Center NIBH Group

  • Counselor
  • Coeur d'Alene, ID
  • NPI 1316096738
  NPD
• Kootenai Urgent Care LLC

  • Family Medicine Physician
  • Coeur d'Alene, ID
  • NPI 1407172059

  Physician Assistant

  NPD
• Kootenai Health, Inc.

  dba Kootenai Medical Center Group

  • Emergency Medicine Physician
  • Coeur d'Alene, ID
  • NPI 1235288655

  Physician Assistant

  NPD (past)
• Ozarks Medical Center

  dba Ozarks Healthcare

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)
• Renown Urgent Care LLC

  dba Fernley Urgent Care

  • Family Medicine Physician
  • Fernley, NV
  • NPI 1821043381

  Physician Assistant

  NPD (past)

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

• Kootenai Health, Inc.

  • General Acute Care Hospital
  • Coeur d'Alene, ID
  • NPI 1992798409
  Care Compare affiliation

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1205901477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 6TH ST",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "838555002",
            "telephone_number": "208-883-2220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 6TH ST",
            "city": "POTLATCH",
            "state": "ID",
            "postal_code": "838555002",
            "telephone_number": "208-883-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "MICHAEL",
        "middle_name": "CLYDE",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte S Ainge, PAC
• Amanda Black, MOT, OTR/L
• Nicholas John Browneller
• County of Latah 285 School District
• Dan Lawson DDS, PC (Potlatch Family Dental)
• Gritman Medical Center Inc (Potlatch Clinic)
• Michael S. Hess, R.PH.
• Lindsay Ranaye Lisher
• Northwest Clinical Services
• Northwest Pharmacy Services Inc (Northwest Pharmacy)

• Physician Assistant in Potlatch, ID
• Providers in Potlatch, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.