Individual provider Active NPI

Matthew Dukelow

  • Physician Assistant
  • Boise, ID
National Provider Identifier
1861174997
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7971574 Issued in ID
Practice address
6052 W State St
Boise, ID 83703-2739
Phone
(208) 344-7799
Fax
(208) 344-7152
NPI assigned
Aug 7, 2023
Last updated
Oct 1, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7971574 ID Primary

Addresses

Primary practice location

6052 W State St
Boise, ID 83703-2739

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6500

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251013003499 ID Practitioner - Physician Assistant 6002303278 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians

Practice addresses (Care Compare)

10482 W Carlton Bay Dr
Garden City, ID 83714-5143
Phone (208) 955-6500

11197 W Fairview Ave
Boise, ID 83713-7935
Phone (208) 378-8011

1375 N Happy Valley Rd
Nampa, ID 83687-5280
Phone (208) 809-2869

1474 N Meridian Rd
Kuna, ID 83634-2041
Phone (208) 809-2885

1475 N Cole Rd
Boise, ID 83704-8537
Phone (208) 809-2880

1900 W Chinden Blvd
Meridian, ID 83646-6690
Phone (208) 809-2860

260 S Ten Mile Rd
Meridian, ID 83642-6100
Phone (208) 809-2872

4971 W Overland Rd
Boise, ID 83705-2822
Phone (208) 472-5050

512 N 21St Ave
Caldwell, ID 83605-4368
Phone (208) 809-2875

6052 W State St
Boise, ID 83703-2739
Phone (208) 947-1947

8971 W Overland Rd
Boise, ID 83709-1651
Phone (208) 378-4288

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7971574IDMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC CurrentSince Oct 27, 2025 Accepting new patients
Alliance Medical Group, LLC CurrentSince Oct 27, 2025 Accepting new patients
Alliance Medical Group, LLC Past Accepting new patients

Locations

6052 W State St
Boise, ID 83703
Phone (208) 344-7799

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

Interoperability endpoints

  • Direct secure messaging: matthew.dukelow@phmg.eclinicaldirectplus.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1691366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1861174997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-955-6500",
            "fax_number": "208-955-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6052 W STATE ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837032739",
            "telephone_number": "208-344-7799",
            "fax_number": "208-344-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUKELOW",
        "first_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-07",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "7971574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.