Dale McKay Belnap, PA-C
Individual provider Active NPI Surgical Physician Assistant · Pocatello, ID
NPI 1962832923 · NPPES record last updated Mar 29, 2018
Key facts
- NPI
- 1962832923
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- PA-1133 (ID)
- Practice address
- 444 Hospital Way Ste 710
Pocatello, ID 83201-2745 - Phone
- (208) 235-4263
- Fax
- (208) 233-4268
- NPI assigned
- Nov 12, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Idaho Regional Hand and Upper Extremity Center PLLC
Practice addresses (Care Compare)
444 Hospital Way
Suite 710
Pocatello, ID 83201-2717
Phone (208) 235-4263
Hospital & facility affiliations
- Cassia Regional Hospital
- Portneuf Medical Center
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 |
|---|---|---|---|---|
| I20140307001190 | ID | Practitioner - Physician Assistant | 6305076548 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA-1133 | ID | MD | Surgical Physician Assistant |
| TLP-019 | ID | MD | Surgical Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | TLP-019 | ID | |
| Surgical Physician Assistant | 363AS0400X | PA-1133 | ID | Yes |
Addresses
Primary practice location
444 Hospital Way Ste 710
Pocatello, ID 83201-2745
Mailing address
444 Hospital Way Ste 710
Pocatello, ID 83201-2745
Phone (208) 235-4263
Other providers in Pocatello, ID
- Belmont Management, Inc.
- Belmont Management, Inc.
- Belnap Chiropractic, P.a.
- Bryndon James Belnap
- Colton Riley Belnap
- Devin Wright Belnap
- Mark Edward Belnap
- C Ric Benedetti
- Lillian Bengtson
- Benjamin Blair, MD PA
All providers in Pocatello, ID · Surgical 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 Mar 29, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.