Active NPI
Matthew A Stelzer, MD
- Pediatrics Physician
- Pocatello, ID
National Provider Identifier
1609844471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- M-12936
- 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
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 |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 808342900 | Medicaid | ID |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160128001755 | ID | Order and Referring Only - Pediatric Medicine | 3375536246 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-12936 | ID | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pocatello Children & Adolescent Clinic | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- mstelzer261968@ahs.direct-ci.com
- 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.
-
- Pediatrics Physician
- Pocatello, ID
- NPI 1700898822
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.