NPIMap

Individual provider Active NPI

Michael J Fall, DO

  • Pulmonary Disease Physician
  • Denver, CO
National Provider Identifier
1851548648
Registry record updated Jun 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
O-1046 Issued in ID
Practice address
535 16TH St
Ste 750
Denver, CO 80202-4228
Phone
(303) 825-4646
Fax
(303) 825-3215
NPI assigned
Aug 22, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X O-1046 ID Primary
Internal Medicine Physician 207R00000X 47743 CO

Addresses

Primary practice location

535 16TH St
Ste 750
Denver, CO 80202-4228

Mailing address

535 16TH St
Ste 750
Denver, CO 80202-4228
Phone (303) 825-4646

Other identifiers 1

IdentifierTypeStateIssuer
12783340MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170714002425 ID Practitioner - Pulmonary Disease 9032260948 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary Disease
Education
Philadelphia College of Osteopathic Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

2347 E Gala St
Meridian, ID 83642-4881
Phone (208) 323-3767

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1698SCMDClinical Social Worker
O-1046IDMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC Internal Medicine CurrentSince Jul 17, 2017 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Internal Medicine CurrentSince Jul 17, 2017 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

2051 E Summersweet Dr
Boise, ID 83716
Phone (208) 323-3767

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

2347 E Gala St
Meridian, ID 83642
Phone (208) 323-0031

Interoperability endpoints

  • Direct secure messaging: mfall87325@direct.slhs.org

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1851548648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 16TH ST",
            "address_2": "STE 750",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802024228",
            "telephone_number": "303-825-4646",
            "fax_number": "303-825-3215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 16TH ST",
            "address_2": "STE 750",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802024228",
            "telephone_number": "303-825-4646",
            "fax_number": "303-825-3215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALL",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-22",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "ID",
            "license": "O-1046",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "47743",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12783340",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.