Individual provider Active NPI

Paul Edward Macmillan, PA-C

  • Physician Assistant
  • Grangeville, ID
National Provider Identifier
1871547158
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
607 W Main St
Grangeville, ID 83530-1345
Phone
(208) 983-8590
NPI assigned
May 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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 Primary

Addresses

Primary practice location

607 W Main St
Grangeville, ID 83530-1345

Mailing address

607 W Main St
Grangeville, ID 83530-1345
Phone (208) 983-8590

Other practice location 1

600 Mt Highway 91 S
Dillon, MT 59725-7379
Phone (406) 683-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address PMACMILLAN237159@WM.PROVIDENCEDIRECT.ORG

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
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
I20151106001326 MT Practitioner - Physician Assistant 9638181506 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
621MTMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: pmacmillan237159@wm.providencedirect.org

Organizations & group practices 2

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": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1871547158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 W MAIN ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301345",
            "telephone_number": "208-983-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W MAIN ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301345",
            "telephone_number": "208-983-8590"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Mt Highway 91 S",
            "address_purpose": "LOCATION",
            "city": "Dillon",
            "state": "MT",
            "postal_code": "597257379",
            "country_code": "US",
            "telephone_number": "406-683-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACMILLAN",
        "first_name": "PAUL",
        "middle_name": "EDWARD",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PMACMILLAN237159@WM.PROVIDENCEDIRECT.ORG",
            "affiliation": "N",
            "address_1": "600 Mt Highway 91 S",
            "city": "Dillon",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597257379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grangeville, ID

Sources for this page

Verify at the official NPI Registry.