Individual provider Active NPI

John Floyd Merrill, D.O.

  • Family Medicine Physician
  • Clarkston, WA
National Provider Identifier
1992152326
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A16056 Issued in CA
Practice address
1119 Highland Ave
Clarkston, WA 99403-2836
Phone
(509) 758-1450
NPI assigned
May 16, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 20A16056 CA Primary

Addresses

Primary practice location

1119 Highland Ave
Clarkston, WA 99403-2836

Mailing address

PO Box 189
Clarkston, WA 99403-0189
Phone (509) 758-1450

Other practice location 1

147 N Brent St
Ventura, CA 93003-2809
Phone (805) 652-5698

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john.merrill@tsmh.medicity.net

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, ID2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190918000812 WA Practitioner - Family Practice 6103112339 Reassigns benefits to 2 organizations
I20191107002683 ID Practitioner - Family Practice 6103112339 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A16056CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-State Memorial Hospital Family Medicine CurrentSince Jul 29, 2019 Accepting new patients
Tri-State Memorial Hospital Multi-Specialty CurrentSince Jul 29, 2019 Accepting new patients
Vannvei LLC CurrentSince Dec 4, 2023 Accepting new patients
Tri-State Memorial Hospital CurrentSince Jan 1, 2026 Accepting new patients
Vannvei LLC Multi-Specialty CurrentSince Dec 4, 2023 Accepting new patients

Locations

1522 17th St
Lewiston, ID 83501
Phone (208) 743-8416

2841 Juniper Dr
#2
Lewiston, ID 83501
Phone (208) 848-9001

1119 Highland Ave
Ste 10
Clarkston, WA 99403
Phone (509) 758-1450

1221 Highland Ave
Clarkston, WA 99403
Phone (509) 751-0312

1119 Highland Ave
Clarkston, WA 99403
Phone (509) 758-1450

Organizations & group practices 5

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": "1463356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1992152326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994030189",
            "telephone_number": "509-758-1450",
            "fax_number": "509-751-1504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032836",
            "telephone_number": "509-758-1450"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "147 N Brent St",
            "address_purpose": "LOCATION",
            "city": "Ventura",
            "state": "CA",
            "postal_code": "930032809",
            "country_code": "US",
            "telephone_number": "805-652-5698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRILL",
        "first_name": "JOHN",
        "middle_name": "FLOYD",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-05-16",
        "last_updated": "2022-07-21",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A16056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.merrill@tsmh.medicity.net",
            "affiliation": "N",
            "address_1": "1119 Highland Ave",
            "city": "Clarkston",
            "state": "WA",
            "country_code": "US",
            "postal_code": "994032836",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clarkston, WA

Sources for this page

Verify at the official NPI Registry.