Individual provider Active NPI

Matthew A Stelzer, MD

  • Pediatrics Physician
  • Pocatello, ID
National Provider Identifier
1609844471
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
M-12936 Issued in ID
Practice address
1151 Hospital Way BLDG F
Pocatello, ID 83201-5091
Phone
(208) 232-1443
Fax
(208) 239-3434
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X M-12936 ID Primary

Addresses

Primary practice location

1151 Hospital Way BLDG F
Pocatello, ID 83201-5091

Mailing address

1151 Hospital Way BLDG F
Pocatello, ID 83201-5091
Phone (208) 232-1443

Other identifiers 1

IdentifierTypeStateIssuer
808342900MedicaidID

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address admin@pocatellochildren.opdirect.net

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160128001755 ID Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 3375536246

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-12936IDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pocatello Children & Adolescent Clinic Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: mstelzer261968@ahs.direct-ci.com
  • Direct secure messaging: admin@pocatellochildren.opdirect.net

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.

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742169600000",
    "number": "1609844471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 HOSPITAL WAY BLDG F",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015091",
            "telephone_number": "208-232-1443",
            "fax_number": "208-239-3434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 HOSPITAL WAY BLDG F",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015091",
            "telephone_number": "208-232-1443",
            "fax_number": "208-239-3434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STELZER",
        "first_name": "MATTHEW",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-12936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808342900",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@pocatellochildren.opdirect.net",
            "affiliation": "N",
            "address_1": "1151 Hospital Way Bldg F",
            "city": "Pocatello",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832015091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.