Roger Wyatt, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M-12951 Issued in ID

Practice address

315 E Elm St
Ste 100
Caldwell, ID 83605

Phone

(208) 302-7100

Fax

(208) 302-7155

NPI assigned

Apr 18, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2012

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Copper Falls Hospice LLC Hospice, Meridian, ID, CCN 131592

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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 and National Provider Directory roles.

• Direct Doctor Care PLLC

  dba Direct Doctor Care

  • Family Medicine Physician
  • Middleton, ID
  • NPI 1871112094
  Medicare reassignment NPD Authorized official
• Psychiatry Services Professional Corporation Khurana Jeider

  dba Psychiatry Connection

  • Psychiatry Physician
  • Las Vegas, NV
  • NPI 1225887375
  NPD

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

• Copper Falls Hospice LLC

  • Community Based Hospice Care Agency
  • Meridian, ID
  • NPI 1881468189
  Care Compare affiliation

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1326305004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3340 E GOLDSTONE WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421026",
            "telephone_number": "208-302-7100",
            "fax_number": "208-302-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E ELM ST",
            "address_2": "STE 100",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "83605",
            "telephone_number": "208-302-7100",
            "fax_number": "208-302-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "ROGER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-18",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "R73187",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-12951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hannah Woody
• Word Mason
• Stacie Workman, LPC
• Lori Lynn Wozniak
• Sheigh Lynn Wright
• Forrest Yeakley, DO
• Rourke Yeakley, MD
• Claire M'Lynn Young, LMT
• Z-Inc (Pauls Pharmacy)
• Dougberto Garcia Zambrano, CADC

• Family Medicine Physician in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2016; 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.