Matthew Wade Black, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-2620 Issued in ID

Practice address

607 W Main St
Grangeville, ID 83530-1345

Phone

(208) 983-1700

Fax

(208) 983-4665

NPI assigned

Aug 29, 2022

Last updated

Oct 25, 2023By the provider in NPPES

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, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Syringa General Hospital District C I FGroup PAC ID 6800707530, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Syringa General Hospital Hospital, Grangeville, ID, CCN 131315

Merit-based Incentive Payment System (MIPS)

Final score

93.78 of 100Reported as apm

Quality

80.38

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Syringa General Hospital District C I F

  • Critical Access Hospital
  • Grangeville, ID
  • NPI 1750336608
  Medicare reassignment Care Compare group
• Syringa General Hospital District C I F

  dba Syringa Primary Care Clinic

  • Primary Care Clinic/Center
  • Grangeville, ID
  • NPI 1073802492
  NPD

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

• Syringa General Hospital District C I F

  • Critical Access Hospital
  • Grangeville, ID
  • NPI 1750336608
  Care Compare affiliation

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

{
    "created_epoch": "1661731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1891415063",
    "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": "208-983-1700",
            "fax_number": "208-983-4665"
        },
        {
            "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": "208-983-1700",
            "fax_number": "208-983-4665"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22 N Main St",
            "address_purpose": "LOCATION",
            "city": "Kooskia",
            "state": "ID",
            "postal_code": "83539",
            "country_code": "US",
            "telephone_number": "208-926-4776",
            "fax_number": "208-926-4696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MATTHEW",
        "middle_name": "WADE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-29",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-2620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terra Bariel
• Nina R Beckwell, MT
• Bentley Counseling and Consulting,PLLC
• Katrina K Bentley, PHD, CNS, NP-C
• Morris Michel Bentley, LCSW
• Cathy S Bostick
• Brown Family Vision, P.C.
• Joel I Brown, O.D.
• Taylor Michael Brown, MD
• Kellie June Bruner, RPH

• Medical Physician Assistant in Grangeville, ID
• Providers in Grangeville, 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 Oct 25, 2023; 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.