NPIMap

Organization Active NPI

Michael G. Summers DDS, Ms, PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Pocatello, ID
National Provider Identifier
1740457332
Registry record updated May 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D-3284-OR Issued in ID
Legal business name
MICHAEL G. SUMMERS DDS, MS, PA
Practice address
1133 Call Creek
Suite B
Pocatello, ID 83202
Phone
(208) 232-0464
Fax
(208) 232-0863
NPI assigned
May 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2008

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

Authorized official

Name
Dr. Michael G. Summers, D.D.S., M.S.
Title
Owner
Phone
(208) 232-0464

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X D-3284-OR ID Primary

Addresses

Primary practice location

1133 Call Creek
Suite B
Pocatello, ID 83202

Mailing address

1133 Call Creek
Suite B
Pocatello, ID 83202
Phone (208) 232-0464

Other identifiers 9

IdentifierTypeStateIssuer
963311OtherIDINSURANCE CO.
645574OtherIDUNITED CONCORDIA INS. CO.
6G405OtherIDINSURANCE CO.
9202522MedicaidID
963311OtherIDUNITED CONCORDIA INSURANCE CO.
000015300MedicaidID
805033500MedicaidID
9201874MedicaidID
6G421OtherIDINSURANCE CO.

National Provider Directory

National Provider Directory

Locations

1133 Call Creek Dr
Ste B
Pocatello, ID 83201
Phone (208) 232-0464

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210636800000",
    "number": "1740457332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 CALL CREEK",
            "address_2": "SUITE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83202",
            "telephone_number": "208-232-0464",
            "fax_number": "208-232-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 CALL CREEK",
            "address_2": "SUITE B",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "83202",
            "telephone_number": "208-232-0464",
            "fax_number": "208-232-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL G. SUMMERS DDS, MS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2008-05-13",
        "status": "A",
        "authorized_official_last_name": "SUMMERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-232-0464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "ID",
            "license": "D-3284-OR",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE CO.",
            "identifier": "963311",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS. CO.",
            "identifier": "645574",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE CO.",
            "identifier": "6G405",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9202522",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INSURANCE CO.",
            "identifier": "963311",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000015300",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805033500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9201874",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INSURANCE CO.",
            "identifier": "6G421",
            "state": "ID"
        }
    ],
    "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 May 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.