NPIMap

Individual provider Active NPI

Richard M Maynard, D.O.

  • Family Medicine Physician
  • Pocatello, ID
National Provider Identifier
1952395063
Registry record updated Feb 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
O-93 Issued in ID
Practice address
110 Vista Dr
Pocatello, ID 83201-5824
Phone
(208) 234-2300
Fax
(208) 234-0026
NPI assigned
Sep 2, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X O-93 ID Primary

Addresses

Primary practice location

110 Vista Dr
Pocatello, ID 83201-5824

Mailing address

110 Vista Dr
Pocatello, ID 83201-5824
Phone (208) 234-2300

Other identifiers 4

IdentifierTypeStateIssuer
002665300MedicaidID
DV104OtherIDBLUE CROSS PROVIDER NUMBE
080179525OtherIDRAILROAD MEDICARE NUMBER
000010003340OtherIDBLUE SHIELD PROVIDER NUMB

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040907001278 ID Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 1658356167 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care Specialists PAGroup PAC ID 4082699574, 5 clinicians

Practice addresses (Care Compare)

110 Vista Dr
Pocatello, ID 83201-5824
Phone (208) 234-2300

Hospital & facility affiliations

  • Enhabit Home Health of Eastern Idaho Home health agency, Idaho Falls, ID, CCN 137105
  • Heritage Home Health Home health agency, Pocatello, ID, CCN 137117
  • Enhabit Home Health of Idaho Home health agency, Twin Falls, ID, CCN 137100
  • Lost Rivers Medical Center Hospital, Arco, ID, CCN 131324
  • Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy12
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
PCS Procedure Suite LLC CurrentSince Apr 18, 2023 Accepting new patients

Locations

110 Vista Dr
Pocatello, ID 83201
Phone (208) 234-0024

Organizations & group practices 2

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 6

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": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391644800000",
    "number": "1952395063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 VISTA DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015824",
            "telephone_number": "208-234-2300",
            "fax_number": "208-234-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 VISTA DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015824",
            "telephone_number": "208-234-2300",
            "fax_number": "208-234-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "RICHARD",
        "middle_name": "M",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2014-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "O-93",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002665300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "DV104",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "080179525",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUMB",
            "identifier": "000010003340",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.