Individual provider Active NPI

Devin Merritt, PHD

  • Psychologist
  • Goodfellow Afb, TX
National Provider Identifier
1568859650
Registry record updated Mar 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
203040 Issued in ID
Practice address
271 Fort Richardson Ave
Goodfellow Afb, TX 76908-4901
Phone
(325) 654-3122
NPI assigned
Apr 16, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 203040 ID Primary

Addresses

Primary practice location

271 Fort Richardson Ave
Goodfellow Afb, TX 76908-4901

Mailing address

271 Fort Richardson Ave
Goodfellow Afb, TX 76908-4901
Phone (325) 654-3122

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191230000934 ID Practitioner - Clinical Psychologist 9931533304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

625 Pole Line Rd W
Twin Falls, ID 83301-4270

746 N College Rd
Twin Falls, ID 83301-3486

815 N College Rd
Twin Falls, ID 83301-3484
Phone (208) 814-9100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
203040IDMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Optimization Psychological Services Current Accepting new patients
St Luke'S Clinic LLC CurrentSince Dec 1, 2019 Accepting new patients
St Luke'S Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

414 Shoup Ave W
#B
Twin Falls, ID 83301
Phone (208) 490-8600

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

550 Polk St
#A
Twin Falls, ID 83301
Phone (208) 736-7090

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1568859650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 FORT RICHARDSON AVE",
            "city": "GOODFELLOW AFB",
            "state": "TX",
            "postal_code": "769084901",
            "telephone_number": "325-654-3122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "271 FORT RICHARDSON AVE",
            "city": "GOODFELLOW AFB",
            "state": "TX",
            "postal_code": "769084901",
            "telephone_number": "325-654-3122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERRITT",
        "first_name": "DEVIN",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-16",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ID",
            "license": "203040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodfellow Afb, TX

Sources for this page

Verify at the official NPI Registry.