Active NPI
Mark Christopher Martindale, PA-C
- Medical Physician Assistant
- Coeur d'Alene, ID
National Provider Identifier
1508416785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA-1937
- Practice address
- 1717 Lincoln Way Ste 108
Coeur D Alene, ID 83814-2556 - Phone
- (208) 480-6174
- Fax
- (208) 601-6174
- NPI assigned
- Sep 18, 2019
- Reactivated
- Feb 24, 2025
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA-1937 | OR | Primary |
Addresses
Primary practice location
1717 Lincoln Way Ste 108
Coeur D Alene, ID 83814-2556
Mailing address
1717 Lincoln Way Ste 108
Coeur D Alene, ID 83814-2556
Phone (208) 480-6174
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1717 Lincoln Way
Suite 108
Coeur D Alene, ID 83814-2556
Phone (208) 480-6174
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-1937 | OR | MD | Medical Physician Assistant |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Coeur d'Alene, ID
- NPI 1194533992
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Coeur d'Alene, ID
- NPI 1992798409
-
dba Northwest Specialty Hospital
- General Acute Care Hospital
- Post Falls, ID
- NPI 1104824739
-
- Sleep Medicine (Psychiatry & Neurology) Physician
- Post Falls, ID
- NPI 1649123589
Hospital
-
- Critical Access Hospital
- Kellogg, ID
- NPI 1043215437
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1568764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741046400000",
"number": "1508416785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 LINCOLN WAY STE 108",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142556",
"telephone_number": "208-480-6174",
"fax_number": "208-601-6174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 LINCOLN WAY STE 108",
"city": "COEUR D ALENE",
"state": "ID",
"postal_code": "838142556",
"telephone_number": "208-480-6174",
"fax_number": "208-601-6174"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINDALE",
"first_name": "MARK",
"middle_name": "CHRISTOPHER",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-09-18",
"last_updated": "2025-03-04",
"certification_date": "2025-03-04",
"deactivation_date": "2025-02-13",
"reactivation_date": "2025-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OR",
"license": "PA-1937",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coeur d'Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; 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.