Active NPI
David A McClusky, M.D.
- Surgery Physician
- Twin Falls, ID
National Provider Identifier
1407896855
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- M4514
- Practice address
- 775 Pole Line Rd W
Suite 214
Twin Falls, ID 83301-5814 - Phone
- (208) 814-8425
- Fax
- (208) 814-8933
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | M4514 | ID | Primary |
Addresses
Primary practice location
775 Pole Line Rd W
Suite 214
Twin Falls, ID 83301-5814
Mailing address
PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003838400 | Medicaid | ID | |
| 020051626 | Other | ID | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M4514 | ID | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magic Valley Regional Medical Center | Past | Accepting new patients | |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Psychiatric Hospital
- Twin Falls, ID
- NPI 1447208947
-
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419811200000",
"number": "1407896855",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 587",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833030587",
"telephone_number": "208-814-7400",
"fax_number": "208-814-7491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 POLE LINE RD W",
"address_2": "SUITE 214",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015814",
"telephone_number": "208-814-8425",
"fax_number": "208-814-8933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLUSKY",
"first_name": "DAVID",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2014-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ID",
"license": "M4514",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003838400",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "020051626",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.