Matthew Wallace Johnson, DO

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

9171859 Issued in ID

Practice address

6640 Kaniksu St
Bonners Ferry, ID 83805-7532

Phone

(208) 267-3141

NPI assigned

Feb 26, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA, ID2 enrollments

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 2

Specialty

Emergency Medicine

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boundary Community HospitalGroup PAC ID 3274583406, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Boundary Community Hospital Hospital, Bonners Ferry, ID, CCN 131301
• Shoshone Medical Center Hospital, Kellogg, ID, CCN 131314

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Boundary Community Hospital

  • Critical Access Hospital
  • Bonners Ferry, ID
  • NPI 1801896683
  Medicare reassignment Care Compare group NPD
• Van Meter Emergency Physicians Inc. Apmc

  • Emergency Medicine Physician
  • Covington, LA
  • NPI 1649410697
  Medicare reassignment NPD
• Gritman Medical Center Inc

  • Critical Access Hospital
  • Moscow, ID
  • NPI 1619988144
  Medicare reassignment
• Shoshone Medical Center

  • Critical Access Hospital
  • Kellogg, ID
  • NPI 1043215437
  Medicare reassignment
• Boundary Community Hospital

  • Emergency Medical Services (Emergency Medicine) Physician
  • Bonners Ferry, ID
  • NPI 1679621098
  NPD
• Boundary Community Hospital

  dba Boundary Community Clinics

  • Rural Health Clinic/Center
  • Bonners Ferry, ID
  • NPI 1801273552
  NPD
• Louisiana State University School of Medicine in New Orleans Faculty G

  dba LSU Healthcare Network

  • Multi-Specialty Clinic/Center
  • New Orleans, LA
  • NPI 1477582526
  NPD (past)
• Western University of Health Sciences

  dba WesternU Patient Care

  • Adult Medicine Physician
  • Lebanon, OR
  • NPI 1639555170
  NPD (past)

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

• Boundary Community Hospital

  • Critical Access Hospital
  • Bonners Ferry, ID
  • NPI 1801896683
  Care Compare affiliation
• Shoshone Medical Center

  • Critical Access Hospital
  • Kellogg, ID
  • NPI 1043215437
  Care Compare affiliation

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

{
    "created_epoch": "1519603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1225539182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6640 KANIKSU ST",
            "city": "BONNERS FERRY",
            "state": "ID",
            "postal_code": "838057532",
            "telephone_number": "208-267-3141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "52579 US-51",
            "address_purpose": "LOCATION",
            "city": "Independence",
            "state": "LA",
            "postal_code": "70443",
            "country_code": "US",
            "telephone_number": "985-878-9421",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25 Jacobs Gulch Rd",
            "address_purpose": "LOCATION",
            "city": "Kellogg",
            "state": "ID",
            "postal_code": "838372023",
            "country_code": "US",
            "telephone_number": "208-784-1221",
            "fax_number": "208-784-0961",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 S Main St",
            "address_purpose": "LOCATION",
            "city": "Moscow",
            "state": "ID",
            "postal_code": "838433046",
            "country_code": "US",
            "telephone_number": "208-882-4511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MATTHEW",
        "middle_name": "WALLACE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-26",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "9171859",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "335074",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "9171859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2524046",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Idaho Dept of Health & Welfare Reg 1 Amh PSR Bonners Ferry
• Idaho Sky Services LLC
• Andrea Jelinek
• Dean Michael Jennings, LCSW
• Kathy Ann Johnson, LM MID75
• Marie Jones, PHARMD
• Joshua Allen Kaufmann, DPT
• Rebecca D Kemp, PA-C
• Mona Kim-Brown, LCPC
• Christopher Michael Kolobow, NP-C

• Emergency Medicine Physician in Bonners Ferry, ID
• Providers in Bonners Ferry, ID by specialty
• Emergency Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; 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.