Idaho Occupational Medicine Group

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

IDAHO OCCUPATIONAL MEDICINE GROUP

Practice address

1839 N Government Way
Coeur D Alene, ID 83814-3454

Phone

(208) 765-0156

Fax

(208) 292-3177

NPI assigned

Feb 19, 2019

Last updated

Aug 25, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Alan Ludwig, MDNPI 1245330208

Title

Owner

Phone

(208) 765-0156

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Coeur d Alene Spine and Sport Other name

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

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.

• Michael A Ludwig, MD

  • Physical Medicine & Rehabilitation Physician
  • Coeur d'Alene, ID
  • NPI 1245330208
  Medicare reassignment NPD Authorized official
• Nicole Marie Parquette, PA-C

  • Physician Assistant
  • Hayden, ID
  • NPI 1841618501
  NPD (past)

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

{
    "created_epoch": "1550534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629849600000",
    "number": "1366908949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 N GOVERNMENT WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838143454",
            "telephone_number": "208-765-0156",
            "fax_number": "208-292-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 N GOVERNMENT WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838143454",
            "telephone_number": "208-765-0156",
            "fax_number": "208-292-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO OCCUPATIONAL MEDICINE GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-19",
        "last_updated": "2021-08-25",
        "certification_date": "2021-08-25",
        "status": "A",
        "authorized_official_last_name": "LUDWIG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-765-0156",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245330208",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coeur d Alene Spine and Sport",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Idaho Dept of Health & Welfare Reg 1 CMH PSR Cda
• Idaho Family Dental Center, PLLC (Davidson Family Dental)
• Idaho Hand & Upper Extremity Therapy
• Idaho Hand & Upper Extremity Therapy DME
• Idaho Medical Transport
• Idaho Outpatient Rehabilitation LLC
• Ideal Family Dental
• Ideal Family Dentistry
• Ideal Option, PLLC
• Indigo Idaho Services, LLC

• Physical Medicine & Rehabilitation Physician in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Physical Medicine & Rehabilitation Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.