NPIMap

Organization Active NPI

Eagle Internal Medicine, PLLC

  • Internal Medicine Physician
  • Eagle, ID
National Provider Identifier
1609004597
Registry record updated Jun 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M10058 Issued in ID
Legal business name
EAGLE INTERNAL MEDICINE, PLLC
Practice address
1025 S Bridge Way PL
Suite 100
Eagle, ID 83616-6834
Phone
(208) 938-0090
NPI assigned
Jun 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2009

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

Authorized official

Name
Dr. Michael A Patmas, M.D.
Title
President
Phone
(208) 938-0090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X M10058 ID Primary

Addresses

Primary practice location

1025 S Bridge Way PL
Suite 100
Eagle, ID 83616-6834

Mailing address

1025 S. Bridgeway PL.
Suite 100
Eagle, ID 83616
Phone (208) 938-0090

Other identifiers 1

IdentifierTypeStateIssuer
C55688OtherUPIN

National Provider Directory

National Provider Directory

Locations

1025 S Bridgeway Pl
Ste 100
Eagle, ID 83616

NPI Registry JSON

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246320000000",
    "number": "1609004597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S. BRIDGEWAY PL.",
            "address_2": "SUITE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "83616",
            "telephone_number": "208-938-0090",
            "fax_number": "208-938-0918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 S BRIDGE WAY PL",
            "address_2": "SUITE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166834",
            "telephone_number": "208-938-0090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE INTERNAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2009-06-30",
        "status": "A",
        "authorized_official_last_name": "PATMAS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-938-0090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M10058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "C55688",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; 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.