Individual provider Active NPI

Patrick P Desmond, M.D.

  • Internal Medicine Physician
  • Twin Falls, ID
National Provider Identifier
1821038282
Registry record updated Dec 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
M3118 Issued in ID
Practice address
775 Pole Line Rd W
Suite 312
Twin Falls, ID 83301-5814
Phone
(208) 814-8600
Fax
(208) 814-8942
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X M3118 ID Primary

Addresses

Primary practice location

775 Pole Line Rd W
Suite 312
Twin Falls, ID 83301-5814

Mailing address

PO Box 587
Twin Falls, ID 83303-0587
Phone (208) 814-7400

Other identifiers 2

IdentifierTypeStateIssuer
000154100MedicaidID
P00029399OtherIDRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M3118IDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Magic Valley Regional Medical Center Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418169600000",
    "number": "1821038282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 587",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833030587",
            "telephone_number": "208-814-7400",
            "fax_number": "208-814-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 POLE LINE RD W",
            "address_2": "SUITE 312",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015814",
            "telephone_number": "208-814-8600",
            "fax_number": "208-814-8942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESMOND",
        "first_name": "PATRICK",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2014-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "ID",
            "license": "M3118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000154100",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00029399",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2014; 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.