Individual provider Active NPI

Joseph Watson, MD

  • Family Medicine Physician
  • Rexburg, ID
National Provider Identifier
1336140664
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M9425 Issued in ID
Practice address
393 E 2ND N
Rexburg, ID 83440-1605
Phone
(208) 356-5401
NPI assigned
Aug 9, 2005
Last updated
Apr 15, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M9425 ID Primary

Addresses

Primary practice location

393 E 2ND N
Rexburg, ID 83440-1605

Mailing address

393 E 2ND N
Rexburg, ID 83440-1605
Phone (208) 356-5401

Other identifiers 1

IdentifierTypeStateIssuer
807021700MedicaidID

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20060213000685 ID Practitioner - Family Practice 3678588605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Madison Co Memorial HospitalGroup PAC ID 8123016367, 34 clinicians

Practice addresses (Care Compare)

393 E 2ND
Rexburg, ID 83440-1605
Phone (208) 359-6498

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M9425IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Co Memorial Hospital Family Medicine CurrentSince Oct 31, 2015 Accepting new patients
Madison Co Memorial Hospital Family Medicine CurrentSince Oct 31, 2015 Accepting new patients
Madison Co Memorial Hospital Current Accepting new patients

Locations

37 S 2nd E
Rexburg, ID 83440
Phone (208) 356-0234

393 E 2nd N
Rexburg, ID 83440
Phone (208) 356-5401

450 E Main St
Rexburg, ID 83440
Phone (208) 356-3691

Interoperability endpoints

  • Direct secure messaging: watsonjo@direct.madisonmemorial.org

Organizations & group practices 3

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 2

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1336140664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E 2ND N",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401605",
            "telephone_number": "208-356-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "393 E 2ND N",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401605",
            "telephone_number": "208-356-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M9425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807021700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.