NPIMap

Individual provider Active NPI

Michael M Packer, M.D.

  • Family Medicine Physician
  • Rexburg, ID
National Provider Identifier
1659454734
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-7243 Issued in ID
Practice address
37 S 2ND E
Rexburg, ID 83440-1906
Phone
(208) 356-0234
NPI assigned
Oct 23, 2006
Last updated
Sep 28, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-7243 ID Primary

Addresses

Primary practice location

37 S 2ND E
Rexburg, ID 83440-1906

Mailing address

37 S 2ND E
Rexburg, ID 83440-1906
Phone (208) 356-0234

Other practice location 1

1 Professional Plz
Rexburg, ID 83440-2024
Phone (208) 356-9231

Other identifiers 1

IdentifierTypeStateIssuer
804159100MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040506001435 ID Practitioner - Family Practice 9436142221 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Washington School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Madison Co Memorial HospitalGroup PAC ID 8123016367, 34 clinicians

Practice addresses (Care Compare)

37 S 2ND
Rexburg, ID 83440-1906
Phone (208) 356-0234

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of skin lesions15
Removal or shaving of skin growth1-10
Skin biopsy20

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Co Memorial Hospital Family Medicine Current Accepting new patients
Madison Memorial Hospital CurrentSince Dec 16, 2017 Accepting new patients
Madison Co Memorial Hospital Family Medicine CurrentSince Sep 26, 2019 Accepting new patients
Madison Co Memorial Hospital CurrentSince Sep 26, 2019 Accepting new patients
Madison Co Memorial Hospital Current Accepting new patients
Madison Co Memorial Hospital Family Medicine Past Accepting new patients
Ashton Memorial, Inc. Past Accepting new patients
Medical Imaging Associates of Idaho Falls, Inc Past Accepting new patients
Cress Creek Healthcare LLC PastSince Sep 1, 2019 Accepting new patients

Locations

37 S 2nd E
Rexburg, ID 83440
Phone (208) 356-0234

37 S 2nd E
Ste 102
Rexburg, ID 83440

393 E 2nd N
Rexburg, ID 83440
Phone (208) 356-5401

450 E Main St
Rexburg, ID 83440
Phone (208) 356-3691

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d61ab3e4-55bb-4859-99e6-22c413b48f2a/
  • Direct secure messaging: mpacker@direct.madisonmemorial.org

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ashton Memorial Living CenterAshton, ID, CCN 135097 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 1, 2020
Oct 1, 2020
Temple View Transitional Care CenterRexburg, ID, CCN 135105 Skilled nursing facility Operational/Managerial Control
Managing Control - Governing Body
Adp of the SNF		 Sep 1, 2019
Sep 1, 2019
Sep 23, 2025
Homestead Home Health & Hospice LLCRexburg, ID, CCN 131579 Hospice Contracted Managing Employee Feb 17, 2017

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1659454734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 S 2ND E",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401906",
            "telephone_number": "208-356-0234",
            "fax_number": "208-656-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 S 2ND E",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834401906",
            "telephone_number": "208-356-0234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Professional Plz",
            "address_purpose": "LOCATION",
            "city": "Rexburg",
            "state": "ID",
            "postal_code": "834402024",
            "country_code": "US",
            "telephone_number": "208-356-9231",
            "fax_number": "208-356-9141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACKER",
        "first_name": "MICHAEL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-7243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804159100",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

Verify at the official NPI Registry.