Matthew Lysne, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

M5825 Issued in ID

Practice address

415 6TH St
Lewiston, ID 83501-2431

Phone

(208) 743-2511

Fax

(208) 799-5554

NPI assigned

Dec 22, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hospitalist Medicine Physicians of Idaho- Nampa PLLC

  • Emergency Medicine Physician
  • Lewiston, ID
  • NPI 1558995316
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1730244542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-743-2511",
            "fax_number": "208-799-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 6TH ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835012431",
            "telephone_number": "208-743-2511",
            "fax_number": "208-799-5554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSNE",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-22",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M5825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF ID GROUP NU",
            "identifier": "8K552",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE OF ID URGENT CARE",
            "identifier": "10003076",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO IND",
            "identifier": "HBRR0",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003805700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8128159",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE OF IDAHO",
            "identifier": "10003077",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luxottica Retail North America Inc (Sears Optical #C0090)
• Breanne L Lybyer, PA-C
• Darby S Lynch, MD
• Joyce Lyons, PH.D., LPC
• Malcom Lee Lyons
• Philip N Mackinnon, PH D
• James F Maguire, DO
• Joyce Arlene Majure, M.D.
• Grover Lynn Mallard, DC
• Cheryl A Mallory, MD

• Emergency Medicine Physician in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Emergency Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.