Active NPI
Matthew Hall
- General Practice Physician
- Bancroft, ID
National Provider Identifier
1932581089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- O-1063
- Practice address
- 1232 Rigby Rd
Bancroft, ID 83217 - Phone
- (208) 251-3800
- NPI assigned
- Jun 25, 2015
- Last updated
- Jun 25, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | O-1063 | ID | Primary |
Addresses
Primary practice location
1232 Rigby Rd
Bancroft, ID 83217
Mailing address
PO Box 119
Bancroft, ID 83217-0119
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| O-1063 | ID | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529884800000",
"number": "1932581089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 119",
"city": "BANCROFT",
"state": "ID",
"postal_code": "832170119"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1232 RIGBY RD",
"city": "BANCROFT",
"state": "ID",
"postal_code": "83217",
"telephone_number": "208-251-3800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "MATTHEW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-06-25",
"last_updated": "2018-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "ID",
"license": "O-1063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bancroft, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.