Melissa D Bates, PA
Individual provider Active NPI Physician Assistant · Idaho Falls, ID
NPI 1962571331 · NPPES record last updated Sep 21, 2018
Key facts
- NPI
- 1962571331
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA513 (ID)
- Practice address
- 808 Pancheri Dr
Idaho Falls, ID 93402-3344 - Phone
- (208) 552-6900
- Fax
- (208) 552-4973
- NPI assigned
- Nov 7, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050413000455 | ID | Practitioner - Physician Assistant | 5294772075 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA513 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Angel Wings Center of Healing | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA513 | ID | Yes |
Addresses
Primary practice location
808 Pancheri Dr
Idaho Falls, ID 93402-3344
Mailing address
3450 Potomac Way
Idaho Falls, ID 83404-4970
Phone (208) 557-2900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 807116800 | Medicaid | ID |
Other names
- Melissa D Cushman
Other providers in Idaho Falls, ID
- Trevor R Bartlett
- Allison Barto
- Leslie Barton
- Jed Terrell Bartschi
- Vincen M Bateman
- Todd Bates
- Battelle Energy Alliance, LLC
- Ka-Sia Michelle Baumer
- Britney Baumgartel
- Cameron S. Baxter
All providers in Idaho Falls, ID · Physician Assistant in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 21, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.