Individual provider Active NPI

Avery Dinallo, DNP, APN, FNP-C

  • Family Nurse Practitioner
  • Meridian, ID
National Provider Identifier
1902328404
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ00744300 Issued in NJ
Practice address
4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442
Phone
(208) 898-7467
Fax
(208) 398-2120
NPI assigned
Jul 17, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ00744300 NJ Primary

Addresses

Primary practice location

4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442

Mailing address

4664 N Penngrove Way Ste 100
Meridian, ID 83646-7442
Phone (208) 898-7467

Other practice location 1

4915 Ehrlich Rd
Tampa, FL 33624-2038
Phone (813) 960-2400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, ID2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200923002866 GA Practitioner - Nurse Practitioner 3678839495 Reassigns benefits to 1 organization
I20220131001232 ID Practitioner - Nurse Practitioner 3678839495 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain Pine Dermatology PLLCGroup PAC ID 8729366455, 10 clinicians

Practice addresses (Care Compare)

4664 N Penngrove Way
Suite 100
Meridian, ID 83646-7442
Phone (208) 898-7467

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

Merit-based Incentive Payment System (MIPS)

Final score
81.94 of 100Reported as group
Quality
69.02
Promoting interoperability
100
Improvement activities
40
Cost
70.79

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00744300NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aqua Dermatology of Georgia PC CurrentSince Aug 10, 2020 Accepting new patients
Mountain Pine Dermatology, PLLC CurrentSince Dec 1, 2021 Accepting new patients
Dermatopathology Lab of Skin Cancer Specialists, P.C. CurrentSince Aug 10, 2020 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients
Christopher G. Nelson, M.D., P.a. Past Accepting new patients

Locations

835 Cogburn Ave NW
Ste 100
Marietta, GA 30060
Phone (770) 422-5557

835 Cogburn Ave NW
Ste 250
Marietta, GA 30060
Phone (770) 422-8815

211 E Logan St
Ste 305
Caldwell, ID 83605
Phone (208) 898-7467

1202 E Locust St
Emmett, ID 83617
Phone (208) 365-2338

4664 N Penngrove Way
Ste 100
Meridian, ID 83646
Phone (208) 452-5999

4664 N Penngrove Way
Meridian, ID 83646

110 Rattlesnake Ave
Ste B
Mountain Home, ID 83647
Phone (208) 587-2226

110 Rattlesnake Ave
Mt Home, ID 83647
Phone (208) 580-9806

3175 Pocahontas Rd
Baker City, OR 97814
Phone (208) 302-2200

Interoperability endpoints

  • Direct secure messaging: adinallo@mtnpinederm.emadirect.md

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1500249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1902328404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467",
            "fax_number": "208-398-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4664 N PENNGROVE WAY STE 100",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836467442",
            "telephone_number": "208-898-7467",
            "fax_number": "208-398-2120"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4915 Ehrlich Rd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336242038",
            "country_code": "US",
            "telephone_number": "813-960-2400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DINALLO",
        "first_name": "AVERY",
        "name_prefix": "Dr.",
        "credential": "DNP, APN, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-17",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00744300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.