NPIMap

Individual provider Active NPI

Samuel Merritt Uebelacker, PA-C

  • Physician Assistant
  • Meridian, ID
National Provider Identifier
1316587751
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1810 Issued in ID
Practice address
2855 E Magic View Dr
Meridian, ID 83642-6245
Phone
(208) 639-4900
NPI assigned
Jan 14, 2020
Last updated
Feb 27, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-1810 ID Primary

Addresses

Primary practice location

2855 E Magic View Dr
Meridian, ID 83642-6245

Mailing address

2855 E Magic View Dr
Meridian, ID 83642-6245
Phone (208) 639-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200306001037 ID Practitioner - Physician Assistant 8123456027 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Idaho Urologic Institute PAGroup PAC ID 9537199039, 20 clinicians

Practice addresses (Care Compare)

222 N 2ND St
Suite 115
Boise, ID 83702-6129
Phone (208) 639-4900

2855 E Magic View Dr
Meridian, ID 83642-6245
Phone (208) 639-4900

6195 E Hunt Ave
Nampa, ID 83687-8317
Phone (208) 639-4900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.29 of 100Reported as group
Quality
52.53
Promoting interoperability
100
Improvement activities
40
Cost
75.1

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho Surgical, LLC PastSince May 1, 2019 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: suebelacker1563433@direct.trinity-health.org

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1578960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582761600000",
    "number": "1316587751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 E MAGIC VIEW DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426245",
            "telephone_number": "208-639-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UEBELACKER",
        "first_name": "SAMUEL",
        "middle_name": "MERRITT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-14",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.