NPIMap

Individual provider Active NPI

Michael John Weaver, MD

  • Gastroenterology Physician
  • Twin Falls, ID
National Provider Identifier
1720427974
Registry record updated Jan 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
2271091 Issued in ID
Practice address
775 Pole Line Rd W Ste 203
Twin Falls, ID 83301-5820
Phone
(208) 814-8300
Fax
(208) 933-4909
NPI assigned
Jun 20, 2013
Last updated
Jan 9, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 2271091 ID Primary
Gastroenterology Physician 207RG0100X 12137545-1205 UT
General Practice Physician 208D00000X 2015013524 MO

Addresses

Primary practice location

775 Pole Line Rd W Ste 203
Twin Falls, ID 83301-5820

Mailing address

660 S Euclid Ave
C B 8121
Saint Louis, MO 63110-1010
Phone (314) 362-5060

Other practice location 1

4901 Forest Park Ave
Ste 2
Saint Louis, MO 63108-1402
Phone (314) 362-5060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, ID, IL3 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 3

Enrollment IDStateProvider typePAC IDDetails
I20210616002532 UT Practitioner - Gastroenterology 5395966816 Reassigns benefits to 2 organizations
I20260121003829 ID Practitioner - Gastroenterology 5395966816 Reassigns benefits to 1 organization
I20260622003110 IL Practitioner - Gastroenterology 5395966816

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Loyola University of Chicago, Stritch School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Gastroenterology LLCGroup PAC ID 9830174150, 71 clinicians
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

6360 S 3000
Suite 310
Salt Lake City, UT 84121-6939
Phone (801) 944-3188

746 N College Rd
Twin Falls, ID 83301-3486

775 Pole Line Rd W
Twin Falls, ID 83301-5820

801 Pole Line Rd W
Twin Falls, ID 83301-5810

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.64 of 100Reported as group
Quality
70.95
Promoting interoperability
78
Improvement activities
40
Cost
76.2

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy73
Upper gastrointestinal (GI) endoscopy for acid reflux86

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2271091IDMDGastroenterology Physician
12137545-1205UTMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Gastroenterology Gastroenterology CurrentSince Feb 1, 2025 Accepting new patients
Granite Peaks Pathology II LLC. Current Accepting new patients
Utah Gastroenterology LLC Gastroenterology Current Accepting new patients
Granite Peaks Gi, LLC Gastroenterology CurrentSince Jul 1, 2021 Accepting new patients
St Luke's Clinic LLC CurrentSince Jan 12, 2026 Accepting new patients
Utah Gastroenterology LLC Gastroenterology CurrentSince Feb 1, 2025 Accepting new patients
Utah Gastroenterology LLC Gastroenterology Current Accepting new patients
Granite Peaks Endoscopy,LLC Past Accepting new patients
St Luke's Magic Valley Regional Medical Center LTD Past Accepting new patients
Utah Gastroenterology LLC Gastroenterology Past Accepting new patients

Locations

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

775 Pole Line Rd W
Ste 203
Twin Falls, ID 83301
Phone (208) 814-8300

620 Medical Dr
Ste 205
Bountiful, UT 84010
Phone (801) 298-0057

2961 W Maple Loop Dr
Ste 220
Lehi, UT 84048
Phone (801) 619-9000

1187 E 3900 S
Salt Lake Cty, UT 84124
Phone (801) 263-3041

6360 S 3000 E
Ste 310
Salt Lake Cty, UT 84121
Phone (801) 944-3144

10150 S Petunia Way
Ste B
Sandy, UT 84092
Phone (801) 619-1115

1393 E Sego Lily Dr
Sandy, UT 84092
Phone (801) 495-5725

368 E Riverside Dr
Ste A
St George, UT 84790
Phone (435) 673-1149

Interoperability endpoints

  • FHIR API: https://4af267b3-0b17-4e37-b82c-3c19f9bce5de.gastro.prod.fhir.ema-api.com/fhir/r4/
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 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": "1371686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767916800000",
    "number": "1720427974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "C B 8121",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-362-5060",
            "fax_number": "314-362-6959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W STE 203",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015820",
            "telephone_number": "208-814-8300",
            "fax_number": "208-933-4909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4901 Forest Park Ave",
            "address_2": "Ste 2",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631081402",
            "country_code": "US",
            "telephone_number": "314-362-5060",
            "fax_number": "314-362-6959",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEAVER",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-20",
        "last_updated": "2026-01-09",
        "certification_date": "2026-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "ID",
            "license": "2271091",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "UT",
            "license": "12137545-1205",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MO",
            "license": "2015013524",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.