Active NPI
David M. McDonald, PA-C
- Surgical Physician Assistant
- Pocatello, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- PA-1016
- Practice address
- 777 Hospital Way
Pocatello, ID 83201-5175 - Phone
- (208) 239-1000
- Fax
- (602) 239-3754
- NPI assigned
- Dec 7, 2010
- Last updated
- Dec 6, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 4780 | AZ | |
| Surgical Physician Assistant | 363AS0400X | PA-1016 | ID | Primary |
Addresses
Primary practice location
777 Hospital Way
Pocatello, ID 83201-5175
Mailing address
777 Hospital Way
Pocatello, ID 83201-5175
Phone (435) 213-0743
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 626417 | Medicaid | AZ |
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
300 S 3Rd
Soda Springs, ID 83276-1559
PO Box
Suite 4168
Pocatello, ID 83205
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-1016 | ID | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pocatello Health Services, LLC | Current | Accepting new patients | |
| Caribou Medical Center, Inc | Current | Accepting new patients | |
| Pocatello Hospital LLC | Current | Accepting new patients | |
| Caribou Medical Center, Inc | Current | Accepting new patients |
Locations
777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000
777 Hospital Way
Ste 201
Pocatello, ID 83201
Phone (208) 239-2260
777 Hospital Way
Ste 202
Pocatello, ID 83201
Phone (208) 239-2640
300 S 3rd W
Soda Springs, ID 83276
Phone (208) 547-0700
Interoperability endpoints
- dmcdonald263738@ahs.direct-ci.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.
-
dba Caribou Medical Center
- Critical Access Hospital
- Soda Springs, ID
- NPI 1942970272
-
dba Lakeview Medical Clinic
- Rural Health Clinic/Center
- Soda Springs, ID
- NPI 1548930878
-
- Durable Medical Equipment & Medical Supplies
- Pocatello, ID
- NPI 1154089126
-
- Internal Medicine Physician
- Pocatello, ID
- NPI 1760610935
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1291680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354752000000",
"number": "1710280144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "777 HOSPITAL WAY",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832015175",
"telephone_number": "435-213-0743",
"fax_number": "208-239-3754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "777 HOSPITAL WAY",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832015175",
"telephone_number": "208-239-1000",
"fax_number": "602-239-3754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCDONALD",
"first_name": "DAVID",
"middle_name": "M.",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-12-07",
"last_updated": "2012-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "AZ",
"license": "4780",
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "ID",
"license": "PA-1016",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "626417",
"state": "AZ"
}
],
"endpoints": [],
"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 Dec 6, 2012; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.