Walter Maitland Graham, M.D.
Individual provider Active NPI Family Medicine Physician · Burley, ID
NPI 1821031758 · NPPES record last updated Feb 26, 2024
Key facts
- NPI
- 1821031758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- M5964 (ID)
- Practice address
- 32 S 150 E
Burley, ID 83318-5450 - Phone
- (208) 677-3034
- Fax
- (208) 677-2483
- NPI assigned
- Jun 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Baylor College of Medicine, 1990
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Ihc Health Services Inc
Practice addresses (Care Compare)
1501 Hiland Ave
Burley, ID 83318-2688
Phone (208) 677-3034
1501 Hiland Ave
Ste. L2
Burley, ID 83318-2682
32 S 150
Burley, ID 83318-5450
Phone (208) 677-3034
Hospital & facility affiliations
- Horizon Home Health Magic Valley
- Intermountain Home Care of Cassia
- Cassia Regional Hospital
- St Lukes Magic Valley Medical Center
- Portneuf Medical Center
- Minidoka Memorial Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 11 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101104000353 | ID | Practitioner - Family Practice | 0648464586 |
Reassigns benefits to 2 organizations Practice locations: Burley, ID |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M5964 | ID | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services, Inc. | Current |
Accepting new patients | |
| Walter M. Graham, M.D. | Family Medicine | Past |
Accepting new patients |
Locations
1501 Hiland Ave
Burley, ID 83318
Phone (208) 678-4444
1501 Hiland Ave
Ste L2
Burley, ID 83318
Phone (208) 677-3034
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | M5964 | ID | Yes |
Addresses
Primary practice location
32 S 150 E
Burley, ID 83318-5450
Mailing address
1501 Hiland Ave
Ste. L2
Burley, ID 83318-2682
Phone (208) 677-3034
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P318303 | Medicaid | ID | |
| 5964-2 | Other | ID | BLUE CROSS |
| 000010002084 | Other | ID | REGENCE BLUESHIELD |
Other providers in Burley, ID
- Gilbert K Crane MD
- Shiloh Gilbert
- Andrea Gochnour
- Alexa Sanaa Gonzales
- Veronica Marie Gonzalez
- Tyson Darrell Greener
- Joshua Ross Greenwell
- Nicholas P Greenwell
- Ashley Guercio
- Olivia NMN Gutierrez
All providers in Burley, ID · Family Medicine Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.