NPIMap

Organization Active NPI

Michael T Harris MD, PC

  • Primary Care Clinic/Center
  • Idaho Falls, ID
National Provider Identifier
1285621532
Registry record updated Nov 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
M 6846 Issued in ID
Legal business name
MICHAEL T HARRIS MD, PC
Practice address
3422 S 15TH E
Idaho Falls, ID 83404-8262
Phone
(208) 552-1222
Fax
(208) 552-3377
NPI assigned
Oct 3, 2005
Last updated
Nov 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2008

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

Authorized official

Name
Dr. Michael T Harris, MDNPI 1952579021
Title
Owner/Practitioner
Phone
(208) 552-1222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X M 6846 ID Primary

Addresses

Primary practice location

3422 S 15TH E
Idaho Falls, ID 83404-8262

Mailing address

3422 S 15TH E
Idaho Falls, ID 83404-8262
Phone (208) 552-1222

Other identifiers 4

IdentifierTypeStateIssuer
P00077360OtherIDRAILROAD MEDICARE
72793OtherIDBLUE CROSS OF IDAHO
003729200MedicaidID
000010000013OtherIDBLUE SHEILD OF IDAHO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227312000000",
    "number": "1285621532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3422 S 15TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048262",
            "telephone_number": "208-552-1222",
            "fax_number": "208-552-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3422 S 15TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048262",
            "telephone_number": "208-552-1222",
            "fax_number": "208-552-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL T HARRIS MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-03",
        "last_updated": "2008-11-22",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "208-552-1222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "ID",
            "license": "M 6846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00077360",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "72793",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003729200",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHEILD OF IDAHO",
            "identifier": "000010000013",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.