Michael Raymond Dibenedetto, M.D.
Individual provider Active NPI Orthopaedic Surgery Physician · Ponderay, ID
NPI 1679644397 · NPPES record last updated Apr 3, 2013
Key facts
- NPI
- 1679644397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- M8578 (ID)
- Practice address
- 30544 Highway 200
Ste 102
Ponderay, ID 83852-5005 - Phone
- (208) 265-9817
- Fax
- (208) 265-4533
- NPI assigned
- Nov 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Ohio State University College of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Michael R Dibenedetto MD PLLC
Boundary Community Hospital
Practice addresses (Care Compare)
30544 Hwy 200
Suite 102
Ponderay, ID 83852-5005
Phone (208) 265-9817
6640 Kaniksu St
Bonners Ferry, ID 83805-7532
Phone (208) 267-3141
Hospital & facility affiliations
- Boundary Community Hospital
- Bonner General Hospital
- Kootenai Health
- Newport Community Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 0
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 1-10 |
| Knee replacement | 1-10 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 1-10 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of tissue | 1-10 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040329001019 | ID | Practitioner - Orthopedic Surgery | 7113819525 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M8578 | ID | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michael R Dibenedetto MD PLLC | Orthopaedic Surgery | Current |
Accepting new patients |
| Boundary Community Hospital | Orthopaedic Surgery | Current |
Accepting new patients |
| Boundary Community Hospital | Current | Accepting new patients | |
| Boundary Community Hospital | Current |
Accepting new patients |
Locations
6640 Kaniksu St
Bonners Ferry, ID 83805
Phone (208) 267-3141
30544 Highway 200
Ste 102
Ponderay, ID 83852
Phone (208) 263-6300
Interoperability endpoints
- michael.dibenedetto@nioasm-id.direct.office.nextgen.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | M8578 | ID | Yes |
Addresses
Primary practice location
30544 Highway 200
Ste 102
Ponderay, ID 83852-5005
Mailing address
30544 Highway 200
Ste 102
Ponderay, ID 83852-5005
Phone (208) 265-9817
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 77010 | Other | ID | BLUE CROSS |
| 806452000 | Medicaid | ID | |
| P00042698 | Other | ID | PALMETTOGBA RAILROAD MEDI |
| 000010140056 | Other | ID | REGENCE |
Other providers in Ponderay, ID
- Jade Dardine
- Kirk D Davidson
- Megan Delaney-Johnson
- Eric Demers
- Bruce William Demko
- John R Diona
- Dr. Paul E. Koch, Optometrist, P.C
- Eden Home Health of Sandpoint, LLC
- Eden Hospice at the Inland Northwest, LLC
- Arleen Mae Erland
All providers in Ponderay, ID · Orthopaedic Surgery Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.