Maurissa Donangelo, PA-C, PHD

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-1970 Issued in ID

Practice address

526 Shoup Ave W Ste E
Twin Falls, ID 83301-5050

Phone

(208) 736-3362

Fax

(208) 736-3382

NPI assigned

May 4, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Maurissa Radakovich Former name

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovative Family Medicine of Idaho PLLCGroup PAC ID 2668820556, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lost Rivers Medical Center Hospital, Arco, ID, CCN 131324
• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
• Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant, Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• Innovative Family Medicine of Idaho PLLC

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1811689870
  Medicare reassignment Care Compare group
• Kenneth C Romney MD Inc

  • Medical Specialty Clinic/Center
  • Twin Falls, ID
  • NPI 1982015822
  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lost Rivers Medical Center

  • Critical Access Hospital
  • Arco, ID
  • NPI 1114925047
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1184155426
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1457414948
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • Psychiatric Hospital Unit
  • Boise, ID
  • NPI 1770687857
  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • Family Medicine Physician
  • Caldwell, ID
  • NPI 1861676298

  Hospital

  Care Compare affiliation
• Saint Alphonsus Regional Medical Center Inc

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1992736649
  Care Compare affiliation
• St. Luke'S Magic Valley Regional Medical Center, LTD.

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1525392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1508355538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1969 9TH AVE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833016707",
            "telephone_number": "801-712-1621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W STE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-736-3362",
            "fax_number": "208-736-3382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONANGELO",
        "first_name": "MAURISSA",
        "credential": "PA-C, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-04",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAURISSA",
            "last_name": "RADAKOVICH",
            "credential": "PA-C, PHD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Chad William Dodds, D.D.S.
• Carolyn S Doedyns, NP
• Donald G Pica MD PA
• Donald L Weese, M.D., P.C.
• Donald P. Workman, MD PA
• Matthew W Dopp, M.D.
• Warren F Dopson, M.D.
• Rachael Dorton, OTD, OTR/L
• Peggy M Doshier, LMSW
• Danielle R Doucet, MD

• Physician Assistant in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.