John Clark Mayberry, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

M-12108 Issued in ID

Practice address

1906 Fairview Ave Ste 130
Caldwell, ID 83605-5433

Phone

(208) 453-4260

Fax

(844) 213-3678

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID, CA, TX3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

General Surgery

Education

Oregon Health Sciences University School of Medicine, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pine Ridge Indian Health Service HospitalGroup PAC ID 4688571326, 107 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pine Ridge IHS Hospital Hospital, Pine Ridge, SD, CCN 430098

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Pine Ridge Indian Health Service Hospital

  • General Acute Care Hospital
  • Pine Ridge, SD
  • NPI 1497786412

  TX

  Medicare reassignment Care Compare group NPD
• St Lukes Clinic - Wood River LLC

  • Internal Medicine Physician
  • Ketchum, ID
  • NPI 1972891604
  Medicare reassignment NPD
• Emergency and Acute Care Medical Corporation

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1437103942
  Medicare reassignment NPD
• KND Development 59 LLC

  • Hospitalist Physician
  • Santa Ana, CA
  • NPI 1740519081
  Medicare reassignment NPD
• Abc Trauma, Inc.

  • Trauma Surgery Physician
  • San Diego, CA
  • NPI 1285266353
  NPD
• KND Development 59 LLC

  • Hospitalist Physician
  • San Diego, CA
  • NPI 1881923951
  NPD
• KND Development 59, LLC

  • Hospitalist Physician
  • Broken Arrow, OK
  • NPI 1922950823
  NPD
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Martin, SD
  • NPI 1003208257
  NPD
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518
  NPD
• Saint Alphonsus Specialty Services Inc

  • Trauma Surgery Physician
  • Boise, ID
  • NPI 1093040479
  NPD (past)

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

• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Martin, SD
  • NPI 1003208257

  Hospital

  Care Compare affiliation
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Kyle, SD
  • NPI 1003963497

  Hospital

  Care Compare affiliation
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Manderson, SD
  • NPI 1487701348

  Hospital

  Care Compare affiliation
• Pine Ridge Indian Health Service Hospital

  • General Acute Care Hospital
  • Pine Ridge, SD
  • NPI 1497786412
  Care Compare affiliation
• Pine Ridge Indian Health Service Hospital

  • Clinic/Center
  • Wanblee, SD
  • NPI 1962559518

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696291200000",
    "number": "1528074077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1074",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836061074",
            "telephone_number": "208-453-4260",
            "fax_number": "844-213-3678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 FAIRVIEW AVE STE 130",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836055433",
            "telephone_number": "208-453-4260",
            "fax_number": "844-213-3678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "JOHN",
        "middle_name": "CLARK",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "ID",
            "license": "M-12108",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M-12108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joe Martinez
• Monique Massey, NP
• Nicholas A Massoth, D.M.D.
• Penny Angel Mata, MEDICAL ASSISTANT
• Charlotte Matos
• Sara L McClellin, LCSW
• Paul A McConnel, MD
• Isaac McConnell
• Wendi McCutchen Adams, LCPC, CADC
• Kaila McDaniel, BS

• Surgery Physician in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Surgery Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.