NPIMap

Individual provider Active NPI

Matthew J Merzlock, PA-C

  • Physician Assistant
  • Idaho Falls, ID
National Provider Identifier
1316985229
Registry record updated Mar 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-553 Issued in ID
Practice address
3360 Washington Pkwy Ste 1
Idaho Falls, ID 83404-8333
Phone
(208) 524-3416
Fax
(208) 524-3138
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2013

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-553 ID Primary

Addresses

Primary practice location

3360 Washington Pkwy Ste 1
Idaho Falls, ID 83404-8333

Mailing address

3360 Washington Pkwy Ste 1
Idaho Falls, ID 83404-8333
Phone (208) 524-3416

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
I20050618000091 ID Practitioner - Physician Assistant 1759325855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tony C Roisum MD PAGroup PAC ID 5991094864, 5 clinicians

Practice addresses (Care Compare)

3360 Washington Pkwy
Suite 1
Idaho Falls, ID 83404-7592
Phone (208) 524-3416

Hospital & facility affiliations

  • Aspen Home Health Services Home health agency, Idaho Falls, ID, CCN 137081
  • Brio Idaho Healthcare Home health agency, Idaho Falls, ID, CCN 137128
  • Advanced Home Health Home health agency, Idaho Falls, ID, CCN 137116
  • Eden Home Health -Idahofalls Home health agency, Idaho Falls, ID, CCN 137119
  • Mission Home Health of Idaho Falls Home health agency, Idaho Falls, ID, CCN 137120
  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018
  • Idaho Falls Community Hospital, LLC Hospital, Idaho Falls, ID, CCN 130074

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-553IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Community Council of Idaho, Inc. Past Accepting new patients

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 and National Provider Directory roles.

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": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363046400000",
    "number": "1316985229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3360 WASHINGTON PKWY STE 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048333",
            "telephone_number": "208-524-3416",
            "fax_number": "208-524-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 WASHINGTON PKWY STE 1",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048333",
            "telephone_number": "208-524-3416",
            "fax_number": "208-524-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERZLOCK",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2013-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.