Matthew Parker, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M14323 Issued in ID

Practice address

Lakeside Pediatric & Adolescent Medicine
980 W Ironwood Drive Suite 302
Coeur D'Alene, ID 83814

Phone

(310) 267-9129

NPI assigned

Mar 30, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mparker627516@direct.multicare.org

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.

• Lakeside Pediatric & Adolescent Medicine, PLLC

  • Pediatric Adolescent Medicine Physician
  • Coeur D'Alene, ID
  • NPI 1003975087
  NPD (past)

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

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554854400000",
    "number": "1487049367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE",
            "address_2": "980 W IRONWOOD DRIVE SUITE 302",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE",
            "address_2": "980 W IRONWOOD DRIVE SUITE 302",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "310-267-9129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARKER",
        "first_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-03-30",
        "last_updated": "2019-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M14323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Lee Norce, DC
• North Idaho Gastroenterology PLLC
• Northwest Behavioral Life Skills
• Northwest Integrated Health, LLP
• Stephanie J Olscamp, CNM
• Brett A Penney, M.D.
• PNW Family Services
• Roman K Poplawski, PH.D.
• R. Randy Hopkins M.D. P.a
• Carissa M Richardson, MD

• Pediatrics Physician in Coeur D'Alene, ID
• Providers in Coeur D'Alene, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.