NPIMap

Individual provider Active NPI

Michael David Schicker, DO

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Ponderay, ID
National Provider Identifier
1861774291
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
License
O0947 Issued in ID
Practice address
30544 Highway 200 Ste 102
Ponderay, ID 83852
Phone
(208) 265-9817
NPI assigned
Sep 12, 2011
Last updated
Sep 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X O0947 ID Primary
Sports Medicine (Orthopaedic Surgery) Physician 207XX0005X OP60637340 WA
Pediatric Orthopaedic Surgery Physician 207XP3100X O0947 ID
Pediatric Orthopaedic Surgery Physician 207XP3100X OP60637340 WA

Addresses

Primary practice location

30544 Highway 200 Ste 102
Ponderay, ID 83852

Mailing address

30544 Highway 200 Ste 102
Ponderay, ID 83852-5005
Phone (208) 265-9817

Other practice location 1

714 W Pine St Bldg C
Newport, WA 99156-9046
Phone (509) 447-3139

Other identifiers 2

IdentifierTypeStateIssuer
807920700MedicaidID
8502734MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, WA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160805002389 ID Practitioner - Orthopedic Surgery 3274849443 Reassigns benefits to 3 organizations
I20170531001025 WA Practitioner - Orthopedic Surgery 3274849443 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Kansas City University of Physicians and Surgeons, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michael R Dibenedetto MD PLLCGroup PAC ID 0840385670, 8 clinicians
Pend Oreille County Public Hospital District No 1Group PAC ID 3274431184, shared by 5 NPIs, 31 clinicians

Practice addresses (Care Compare)

30544 Hwy 200
Suite 102
Ponderay, ID 83852-5005
Phone (208) 265-9817

714 W Pine St
Newport, WA 99156-9046

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement17
Knee replacement22
Lower limb (leg) arthroscopy (minimally invasive joint repair)16
Upper limb (arm) arthroscopy (minimally invasive joint repair)14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
O0947IDMDPediatric Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Michael R Dibenedetto MD PLLC CurrentSince Sep 1, 2016 Accepting new patients
Pend Oreille County Public Hospital District No 1 CurrentSince Jun 1, 2017 Accepting new patients
Pend Oreille County Public Hospital District No 1 CurrentSince Jun 1, 2017 Accepting new patients
Pend Oreille County Public Hospital District No 1 CurrentSince Dec 3, 2025 Accepting new patients
Boundary Community Hospital CurrentSince Aug 26, 2016 Accepting new patients
Boundary Community Hospital CurrentSince Aug 26, 2016 Accepting new patients
Pend Oreille County Public Hospital District No. 1 Past Accepting new patients
Boundary Community Hospital Past Accepting new patients
Pend Oreille County Public Hospital District No 1 Past Accepting new patients
Pend Oreille County Public Hospital District No 1 Past Accepting new patients

Locations

6640 Kaniksu St
Bonners Ferry, ID 83805
Phone (208) 267-3141

30544 Highway 200
Ste 102
Ponderay, ID 83852
Phone (208) 265-9817

714 W Pine St
Newport, WA 99156
Phone (509) 447-2441

714 W Pine St
Bldg C
Newport, WA 99156
Phone (509) 447-3139

Interoperability endpoints

  • Direct secure messaging: mike.schicker@nioasm-id.direct.office.nextgen.com
  • Direct secure messaging: mschicker1410410@wm.providencedirect.org

Organizations & group practices 10

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.

Hospital & facility affiliations 7

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": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1861774291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200 STE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "838525005",
            "telephone_number": "208-265-9817",
            "fax_number": "530-541-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30544 HIGHWAY 200 STE 102",
            "city": "PONDERAY",
            "state": "ID",
            "postal_code": "83852",
            "telephone_number": "208-265-9817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "714 W Pine St Bldg C",
            "address_purpose": "LOCATION",
            "city": "Newport",
            "state": "WA",
            "postal_code": "991569046",
            "country_code": "US",
            "telephone_number": "509-447-3139",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCHICKER",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-12",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "ID",
            "license": "O0947",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "WA",
            "license": "OP60637340",
            "primary": false
        },
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "ID",
            "license": "O0947",
            "primary": false
        },
        {
            "code": "207XP3100X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Pediatric Orthopaedic Surgery",
            "state": "WA",
            "license": "OP60637340",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807920700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8502734",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponderay, ID

Sources for this page

Verify at the official NPI Registry.