Michael Ray Haskell, PA-C
Individual provider Active NPI Medical Physician Assistant · Driggs, ID
NPI 1457794083 · NPPES record last updated Dec 14, 2016
Key facts
- NPI
- 1457794083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 576 (WY)
- Practice address
- 120 East Howard Avenue
Teton Valley Health Care
Driggs, ID 83422-5112 - Phone
- (208) 354-6302
- Fax
- (208) 354-3158
- NPI assigned
- Apr 13, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Teton Valley Health Care Inc
Practice addresses (Care Compare)
120 E Howard Ave
Driggs, ID 83422-5112
120 E Howard St
Driggs, ID 83422-5112
Phone (208) 354-2383
Hospital & facility affiliations
- Teton Valley Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150909002119 | ID | Practitioner - Physician Assistant | 4183859937 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 576 | WY | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teton Valley Health Care Inc | Orthopaedic Surgery | Current | Accepting new patients |
| Teton Valley Health Care Inc | Current |
Accepting new patients | |
| North Lincoln County Hospital District | Past | Accepting new patients | |
| North Lincoln County Hospital District | Past | Accepting new patients | |
| Medical Imaging Associates of Idaho Falls, Inc | Past | Accepting new patients |
Locations
120 E Howard St
Driggs, ID 83422
Phone (208) 354-2302
283 N 1st St
Driggs, ID 83422
Phone (208) 354-2302
Interoperability endpoints
- michael.haskell.1@15468.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 576 | WY | Yes |
| Surgical Physician Assistant | 363AS0400X | 576 | WY |
Addresses
Primary practice location
120 East Howard Avenue
Teton Valley Health Care
Driggs, ID 83422-5112
Mailing address
120 East Howard Avenue
Teton Valley Health Care
Driggs, ID 83422-5112
Phone (208) 354-6352
Other providers in Driggs, ID
- FPC PLLC
- Anna Giemza-Palmer
- Rilee Glenn
- Lisa K Grutzmacher
- Anna McCamy Gunderson
- High Peaks Physical Therapy P a
- Stephanie Lee Hill
- Chad Rodger Horrocks
- Hunters Inc
- Hunters Incorporated
All providers in Driggs, ID · Medical Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.