NPIMap

Individual provider Active NPI

Marlo Pichardo, PAC

  • Physician Assistant
  • Eagle, ID
National Provider Identifier
1699842021
Registry record updated Feb 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1898 Issued in ID
Practice address
408 S Eagle Rd Ste 205
Eagle, ID 83616-6079
Phone
(208) 740-8797
Fax
(530) 237-0772
NPI assigned
Nov 29, 2006
Last updated
Feb 13, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9102903 FL
Physician Assistant 363A00000X PA-1898 ID Primary

Addresses

Primary practice location

408 S Eagle Rd Ste 205
Eagle, ID 83616-6079

Mailing address

408 S Eagle Rd Ste 205
Eagle, ID 83616-6079
Phone (208) 740-8797

Other names 1

  • Marlo Smith Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050628001103 FL Practitioner - Physician Assistant 3577509793 Reassigns benefits to 1 organization
I20200728003160 ID Practitioner - Physician Assistant 3577509793 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Momentum Medical Group of Idaho LLCGroup PAC ID 2668824608, 8 clinicians

Practice addresses (Care Compare)

215 E Hawaii Ave
Suite 270
Nampa, ID 83686-6011
Phone (208) 468-5920

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9102903FLMDPhysician Assistant
PA-1898IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Momentum Medical Group of Idaho LLC CurrentSince Dec 18, 2025 Accepting new patients
Steward Medical Group, Inc CurrentSince Sep 9, 2019 Accepting new patients
Osprey Emergency Physicians LLC Past Accepting new patients
Brevard Emergency Services Past Accepting new patients
Emergency Physician Solutions of North Florida, LLC Past Accepting new patients
Florida Em-I Medical Services PA Past Accepting new patients
Clover Emergency Physicians LLC Past Accepting new patients
Floridian Emergency Specialists, LLC PastSince Jan 26, 2020 Accepting new patients

Locations

250 N Wickham Rd
Melbourne, FL 32935
Phone (321) 637-2600

8854 W Emerald St
Ste 140
Boise, ID 83704
Phone (208) 321-4790

8950 W Emerald St
Ste 195
Boise, ID 83704
Phone (208) 376-7313

215 E Hawaii Ave
Ste 270
Nampa, ID 83686
Phone (208) 468-5920

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IEHCDD

Organizations & group practices 10

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 1

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": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770940800000",
    "number": "1699842021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 S EAGLE RD STE 205",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166079",
            "telephone_number": "208-740-8797",
            "fax_number": "530-237-0772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 S EAGLE RD STE 205",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166079",
            "telephone_number": "208-740-8797",
            "fax_number": "530-237-0772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICHARDO",
        "first_name": "MARLO",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2026-02-13",
        "certification_date": "2026-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9102903",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARLO",
            "last_name": "SMITH",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eagle, ID

Sources for this page

Verify at the official NPI Registry.