NPIMap

Individual provider Active NPI

Michael Todd Burtis, M.D.

  • Diagnostic Radiology Physician
  • Lewiston, ID
National Provider Identifier
1396765335
Registry record updated Apr 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
M13009 Issued in ID
Practice address
531 4TH Ave
Lewiston, ID 83501-2450
Phone
(208) 743-4393
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X MD 13873 HI
Diagnostic Radiology Physician 2085R0202X M13009 ID Primary

Addresses

Primary practice location

531 4TH Ave
Lewiston, ID 83501-2450

Mailing address

531 4TH Ave
Lewiston, ID 83501-2450
Phone (208) 743-4393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150831000866 ID Practitioner - Diagnostic RadiologyPractitioner - Interventional Radiology 9830405281 Reassigns benefits to 3 organizations
I20200731000944 WA Practitioner - Diagnostic Radiology 9830405281 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Interventional Radiology
Education
Medical College of Wisconsin, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tri-State Memorial HospitalGroup PAC ID 4082502422, 33 clinicians
Vannvei LLCGroup PAC ID 1254743420, 19 clinicians
Phoenix Radiology, PLLCGroup PAC ID 1254390354, 8 clinicians

Practice addresses (Care Compare)

1221 Highland Ave
Clarkston, WA 99403-2829
Phone (509) 758-5511

1522 17TH St
Lewiston, ID 83501-3652
Phone (208) 743-8416

531 4TH Ave
Lewiston, ID 83501-2450
Phone (208) 743-4393

Hospital & facility affiliations

  • St Joseph Regional Medical Center Hospital, Lewiston, ID, CCN 130003
  • Syringa General Hospital Hospital, Grangeville, ID, CCN 131315
  • Tri-State Memorial Hospital Hospital, Clarkston, WA, CCN 501332
  • St Mary'S Hospital Hospital, Cottonwood, ID, CCN 131321
  • Kootenai Health Hospital, Coeur D'Alene, ID, CCN 130049

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 13873HIMDDiagnostic Radiology Physician
M13009IDMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-State Memorial Hospital CurrentSince Jul 1, 2020 Accepting new patients
Tri-State Memorial Hospital CurrentSince Feb 1, 2020 Accepting new patients
Vannvei LLC CurrentSince Mar 9, 2021 Accepting new patients
Phoenix Radiology, PLLC Diagnostic Radiology CurrentSince Oct 1, 2015 Accepting new patients
Tri-State Memorial Hospital CurrentSince Feb 1, 2020 Accepting new patients
Vannvei LLC CurrentSince Mar 9, 2021 Accepting new patients

Locations

1522 17th St
Lewiston, ID 83501
Phone (208) 743-8416

415 6th St
Lewiston, ID 83501
Phone (208) 750-7445

531 4th Ave
Lewiston, ID 83501
Phone (208) 743-4393

2841 Juniper Dr
#2
Lewiston, ID 83501
Phone (208) 848-9001

1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312

Organizations & group practices 8

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 12

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460332800000",
    "number": "1396765335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 4TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012450",
            "telephone_number": "208-743-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 4TH AVE",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012450",
            "telephone_number": "208-743-4393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURTIS",
        "first_name": "MICHAEL",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2016-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "HI",
            "license": "MD 13873",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ID",
            "license": "M13009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.