Merrick Gordon Reynolds, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA876 Issued in ID

Practice address

526 Shoup Ave W
Suite E
Twin Falls, ID 83301-5050

Phone

(208) 733-1112

Fax

(208) 732-1212

NPI assigned

Nov 17, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Innovative Family Medicine of Idaho PLLCGroup PAC ID 2668820556, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lost Rivers Medical Center Hospital, Arco, ID, CCN 131324
• St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Innovative Family Medicine of Idaho PLLC

  • Family Medicine Physician
  • Twin Falls, ID
  • NPI 1811689870
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lost Rivers Medical Center

  • Critical Access Hospital
  • Arco, ID
  • NPI 1114925047
  Care Compare affiliation
• St. Luke's Magic Valley Regional Medical Center, LTD.

  dba St Lukes Magic Valley - Air Ambulance

  • General Acute Care Hospital
  • Twin Falls, ID
  • NPI 1932154705
  Care Compare affiliation

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

{
    "created_epoch": "1289952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289952000000",
    "number": "1891097234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W",
            "address_2": "SUITE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-733-1112",
            "fax_number": "208-732-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 SHOUP AVE W",
            "address_2": "SUITE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015050",
            "telephone_number": "208-733-1112",
            "fax_number": "208-732-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MERRICK",
        "middle_name": "GORDON",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-17",
        "last_updated": "2010-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Resolutions Therapy Plus and Retreat Center
• Patrick Kevin Rexroat, LMSW
• Brooke Suzanne Rey, ATC, LAT
• Renette Leona Reyes
• Erika Anne Reynolds, M.S., CCC-SLP
• Brian Rhodes
• Lynn Roselle Rice, LCSW
• Richard W Worst MD PA
• Andrew Keith Richards, DDS
• Kelson Richards, DPT

• Medical Physician Assistant in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.