Mr Michael Clyde Graham, PA is a medicare enrolled "Physician Assistant" in Potlatch, Idaho. He graduated from nursing school in 1989 and has 37 years of diverse experience with area of expertise as Physician Assistant. He is a member of the group practice Kootenai Urgent Care Llc and his current practice location is
225 6th St, Potlatch, Idaho. You can reach out to his office (for appointments etc.) via phone at
(208) 883-2220.
Mr Michael Clyde Graham is licensed to practice in Idaho (license number PA594) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1205901477.
Provider's Profile
| Full Name | Mr Michael Clyde Graham |
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| Gender | Male |
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| Speciality | Physician Assistant |
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| Experience | 37 Years |
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| Location | 225 6th St, Potlatch, Idaho |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Mr Michael Clyde Graham graduated from nursing school in 1989
NPI Data:
- NPI Number: 1205901477
- Provider Enumeration Date: 11/22/2006
- Last Update Date: 06/20/2012
Medicare PECOS Information:
- PECOS PAC ID: 3971578196
- Enrollment ID: I20060209000488
Medical Identifiers
Medical identifiers for Mr Michael Clyde Graham such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1205901477 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363A00000X | Physician Assistant | PA594 (Idaho) | Primary |
Medical Facilities Affiliation
| Facility Name | Location | Facility Type |
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| Kootenai Health | Coeur d'alene, ID | Hospital |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Kootenai Urgent Care Llc | 1052441946 | 19 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Michael Clyde Graham allows following entities to bill medicare on his behalf.
| Entity Name | Kootenai Urgent Care LLC |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1821312356
PECOS PAC ID: 1052441946
Enrollment ID: O20100621000358 |
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| Entity Name | Kootenai Health Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1174661151
PECOS PAC ID: 1355792276
Enrollment ID: O20240111003252 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Michael Clyde Graham is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mr Michael Clyde Graham, PA
225 6th St,
Potlatch, ID 83855-5002
Ph: (208) 883-2220 | Mr Michael Clyde Graham, PA
225 6th St,
Potlatch, ID 83855-5002
Ph: (208) 883-2220 |
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