NPIMap

Individual provider Active NPI

Michael Bryon Spackman, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Meridian, ID
National Provider Identifier
1386887032
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
M11335 Issued in ID
Practice address
360 E Montvue Dr
Suite 100
Meridian, ID 83642
Phone
(208) 855-2900
NPI assigned
Apr 10, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X M11335 ID Primary

Addresses

Primary practice location

360 E Montvue Dr
Suite 100
Meridian, ID 83642

Mailing address

2835 N Tanglerose PL
Eagle, ID 83616-5796
Phone (952) 239-5080

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
I20110815000871 ID Practitioner - Physical Medicine and RehabilitationPractitioner - Pain Management 4486840741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and RehabilitationAlso: Pain Management
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spine Institute of Idaho PAGroup PAC ID 6608837265, 5 clinicians

Practice addresses (Care Compare)

360 E Montvue Dr
Meridian, ID 83642-6318
Phone (208) 855-2900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
80.2 of 100Reported as individual
Quality
56.39
Promoting interoperability
99
Improvement activities
40
Cost
78.44

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M11335IDMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spine Institute of Idaho P a CurrentSince Sep 6, 2011 Accepting new patients

Locations

1906 Fairview Ave
Ste 420
Caldwell, ID 83605
Phone (208) 855-2900

360 E Montvue Dr
#100
Meridian, ID 83642
Phone (208) 855-2900

Interoperability endpoints

  • Direct secure messaging: michael.spackman.1@10048.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/10048/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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 11

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": "1239321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531267200000",
    "number": "1386887032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 N TANGLEROSE PL",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165796",
            "telephone_number": "952-239-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 E MONTVUE DR",
            "address_2": "SUITE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "83642",
            "telephone_number": "208-855-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPACKMAN",
        "first_name": "MICHAEL",
        "middle_name": "BRYON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-10",
        "last_updated": "2018-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "ID",
            "license": "M11335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.