MICHAEL R DIBENEDETTO MD PLLC (NPI# 1073757464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073757464 |
| Entity Type | Organization |
| Organization Name | MICHAEL R DIBENEDETTO MD PLLC |
| Other Organization Name | SEASONS PLASTIC & RECONSTRUCTIVE SURGERY |
| Practice Address |
30544 Highway 200 Suite 102 Ponderay ID 83852-5005 |
| Practice Telephone | 2082635900 |
| Practice Fax Number | 2082631319 |
| Mailing Telephone | 2082635900 |
| Mailing Fax Number | 2082631319 |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2009-10-21 |
| Authorized Official Name | WENDY S BROSNAHAN (OFFICE MANAGER) |
| Authorized Official Telephone | 2082635900 |
| Is Organization Subpart | Y |
| Parent Organization Name | MICHAEL R DIBENEDETTO MD PLLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
M10671 | ID | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE CROSS | 8N834 | 01 |
| ID | RAIL ROAD MEDICARE | DG3627 | 01 |
| Other Name | Type Code |
|---|---|
| Seasons Plastic & Reconstructive Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083809727 | Michael R Dibenedetto Md Pllc | Orthopaedic Surgery | 30544 Hwy 200, Ste 102, Ponderay, ID 83852 | 2007-09-06 |
| Street Address |
30544 HIGHWAY 200 SUITE 102 |
| City | PONDERAY |
| State | ID |
| Zip Code | 83852-5005 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780651539 | Bruce William Demko | Nurse Anesthetist, Certified Registered | 30544 Highway 200, Ponderay, ID 83852-5005 | 2006-03-01 |
| 1679110845 | Angela Alice Chapin | Massage Therapist | 30544 Highway 200, Ponderay, ID 83852-5005 | 2019-12-05 |
| 1851894018 | Jessica Hunt | Massage Therapist | 30544 Highway 200, Ponderay, ID 83852-5005 | 2018-03-14 |
| 1235649625 | Kauai In-home Therapy LLC | Clinic/Center | 30544 Highway 200, Ponderay, ID 83852-5005 | 2017-10-11 |
| 1932527389 | Stuart Gall Crna Inc | Nurse Anesthetist, Certified Registered | 30544 Highway 200, Suite 201, Ponderay, ID 83852-5005 | 2014-04-02 |
| 1669756813 | Nichole Suzanne Grimm | Nurse Practitioner | 30544 Highway 200, Ste 101, Ponderay, ID 83852-5005 | 2011-10-06 |
| 1891969606 | Jonathan Donald Fisher | Podiatrist | 30544 Highway 200, Suite 102, Ponderay, ID 83852-5005 | 2008-04-14 |
| 1376713008 | Bruce Demko Crna Inc | Nurse Anesthetist, Certified Registered | 30544 Highway 200, Ponderay, ID 83852-5005 | 2008-03-10 |
| 1821276353 | Pend Oreille Surgery Center LLC | Clinic/Center | 30544 Highway 200, Suite 201, Ponderay, ID 83852-5005 | 2008-02-06 |
| 1679644397 | Michael Raymond Dibenedetto | Orthopaedic Surgery | 30544 Highway 200, Ste 102, Ponderay, ID 83852-5005 | 2006-11-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346606647 | Vern Stairs | Pharmacist | 476999 Us-95, Walmart Supercenter, Ponderay, ID 83852 | 2016-01-04 |
| 1083809727 | Michael R Dibenedetto Md Pllc | Orthopaedic Surgery | 30544 Hwy 200, Ste 102, Ponderay, ID 83852 | 2007-09-06 |
| 1811009988 | David Paul Cox | Dentist | 477542 Hwy 95 N, Ponderay, ID 83852 | 2006-08-31 |
| 1861774291 | Michael David Schicker | Orthopaedic Surgery | 30544 Highway 200 Ste 102, Ponderay, ID 83852 | 2011-09-12 |
| 1750410825 | Glacier Prosthetic Care, Inc. | Prosthetic/Orthotic Supplier | 205 Vermeer Dr, Suite C, Ponderay, ID 83852-1660 | 2007-03-05 |
| 1083949531 | Mario E Roxas | Naturopath | 476864 Highway 95, Suite #3, Ponderay, ID 83852-5000 | 2009-10-15 |
| 1942716246 | Darwin L Hurst | Family Medicine | 30544 Highway 200 Ste 101, Ponderay, ID 83852-5005 | 2017-12-21 |
| 1902036734 | Innovative Anesthesia | Nurse Anesthetist, Certified Registered | 30544 Highway 200 Ste 201, Pend Oreille Surgery Center, Ponderay, ID 83852-5005 | 2009-07-14 |
| 1255597811 | Travis Lee Taylor | Nurse Practitioner | 30544 Highway 200 Ste 102, Ponderay, ID 83852-5005 | 2008-08-04 |
| 1982741195 | Ryan Leisy | Chiropractor | 30544 Highway 200 Ste 330, Ponderay, ID 83852-5005 | 2007-01-30 |
| Find all providers in zip 83852 | ||||
| Taxonomy Code | 2086S0122X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Plastic and Reconstructive Surgery |
| A surgeon who specializes in plastic and reconstructive surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427523968 | Q17 Health Partners LLC | Surgery | 100 East Idaho Street #317, Boise, ID 83712 | 2018-10-11 |
| 1588877641 | John Arthur Jarrell Iv | Surgery | 3090 E Gentry Way Ste 210, Meridian, ID 83642-3550 | 2007-05-07 |
| 1265656268 | David William Becker Jr. | Surgery | 668 Ballingrude Dr, Twin Falls, ID 83301-4403 | 2007-04-12 |
| 1912046210 | Center for Aesthetics PC | Surgery | 2375 E Sunnyside Road, Suite G, Idaho Falls, ID 83404 | 2007-02-05 |
| 1073668042 | Thomas Floyd Crais Jr. | Surgery | 315 S River St, Hailey, ID 83333-8426 | 2007-01-23 |
| 1003823956 | Craig B. Bass | Surgery | 250 Bobwhite Ct, # 275, Boise, ID 83706-6643 | 2006-08-02 |
| 1427086164 | Mark David Wigod | Surgery | 3630 E Louise Drive, Meridian, ID 83642 | 2006-06-29 |
| 1629069885 | Patrick James Mullen | Surgery | 2121 W Ironwood Center Dr, Coeur D Alene, ID 83814-2639 | 2005-11-04 |
| 1477195931 | Jarrell Plastic Surgery | Surgery | 3090 E Gentry Way Ste 210, Meridian, ID 83642-3550 | 2019-10-16 |
| 1720381536 | Patrick J Mullen Md Pllc | Surgery | 750 N Syringa St, Suite 204, Post Falls, ID 83854-5275 | 2010-12-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.