| Michael Raymond Dibenedetto, MD | |
|
30544 Highway 200, Ste 102, Ponderay, ID 83852-5005 | |
| (208) 265-9817 | |
| (208) 265-4533 |
| Full Name | Michael Raymond Dibenedetto |
|---|---|
| Gender | Male |
| Speciality | Orthopedic Surgery |
| Experience | 41 Years |
| Location | 30544 Highway 200, Ponderay, Idaho |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679644397 | NPI | - | NPPES |
| 77010 | Other | ID | BLUE CROSS |
| 806452000 | Medicaid | ID | |
| P00042698 | Other | ID | PALMETTOGBA RAILROAD MEDI |
| 000010140056 | Other | ID | REGENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | M8578 (Idaho) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Boundary Community Hospital | Bonners ferry, ID | Hospital |
| Bonner General Hospital | Sandpoint, ID | Hospital |
| Kootenai Health | Coeur d'alene, ID | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Michael R Dibenedetto Md Pllc | 0840385670 | 9 |
| Boundary Community Hospital | 3274583406 | 29 |
| Entity Name | Boundary Community Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801896683 PECOS PAC ID: 3274583406 Enrollment ID: O20050126000312 |
| Entity Name | Michael R Dibenedetto Md Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083809727 PECOS PAC ID: 0840385670 Enrollment ID: O20071009000187 |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Raymond Dibenedetto, MD 30544 Highway 200, Ste 102, Ponderay, ID 83852-5005 Ph: (208) 265-9817 | Michael Raymond Dibenedetto, MD 30544 Highway 200, Ste 102, Ponderay, ID 83852-5005 Ph: (208) 265-9817 |
Michael David Schicker, DO Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 30544 Highway 200 Ste 102, Ponderay, ID 83852 Phone: 208-265-9817 |