Individual provider Active NPI

Alison Naomi Wheatley, PA-C

  • Medical Physician Assistant
  • Coeur D Alene, ID
National Provider Identifier
1932503596
Registry record updated Jul 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA-1365 Issued in ID
Practice address
1090 W Park PL
Coeur D Alene, ID 83814-2785
Phone
(208) 292-0292
NPI assigned
Oct 10, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5753 AZ
Medical Physician Assistant 363AM0700X PA-1365 ID Primary

Addresses

Primary practice location

1090 W Park PL
Coeur D Alene, ID 83814-2785

Mailing address

1090 W Park PL
Coeur D'Alene, ID 83814
Phone (208) 292-0292

Other identifiers 2

IdentifierTypeStateIssuer
PA-1365OtherIDSTATE LICENSE
5753OtherAZ5753

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20160708000818 ID Practitioner - Physician Assistant 2062733611 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as apm
Quality
89.26
Promoting interoperability
69.9
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5753AZMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group Arizona LLC Past Accepting new patients
Deseret Family Practice, LTD. PastSince Sep 13, 2002 Accepting new patients

Organizations & group practices 4

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": "1412899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1932503596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 W PARK PL",
            "city": "COEUR D'ALENE",
            "state": "ID",
            "postal_code": "83814",
            "telephone_number": "208-292-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 W PARK PL",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142785",
            "telephone_number": "208-292-0292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEATLEY",
        "first_name": "ALISON",
        "middle_name": "NAOMI",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-10",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "5753",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1365",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PA-1365",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "5753",
            "identifier": "5753",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur D Alene, ID

Sources for this page

Verify at the official NPI Registry.