NPIMap

Individual provider Active NPI

Michael Raymond Dibenedetto, M.D.

  • Orthopaedic Surgery Physician
  • Ponderay, ID
National Provider Identifier
1679644397
Registry record updated Apr 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
M8578 Issued in 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
Last updated
Apr 3, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X M8578 ID Primary

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

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
I20040329001019 ID Practitioner - Orthopedic Surgery 7113819525 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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 PLLCGroup PAC ID 0840385670, 8 clinicians
Boundary Community HospitalGroup PAC ID 3274583406, 29 clinicians

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

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
0

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M8578IDMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michael R Dibenedetto MD PLLC Orthopaedic Surgery CurrentSince Sep 1, 2002 Accepting new patients
Boundary Community Hospital Orthopaedic Surgery CurrentSince Apr 1, 2015 Accepting new patients
Boundary Community Hospital CurrentSince Apr 1, 2015 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) 265-9817

Interoperability endpoints

  • Direct secure messaging: michael.dibenedetto@nioasm-id.direct.office.nextgen.com

Organizations & group practices 4

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 4

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": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364947200000",
    "number": "1679644397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200",
            "address_2": "STE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525005",
            "telephone_number": "208-265-9817",
            "fax_number": "208-265-4533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200",
            "address_2": "STE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525005",
            "telephone_number": "208-265-9817",
            "fax_number": "208-265-4533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIBENEDETTO",
        "first_name": "MICHAEL",
        "middle_name": "RAYMOND",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ID",
            "license": "M8578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponderay, ID

Sources for this page

Verify at the official NPI Registry.