JOHN DAVID MCDERMOTT (P.A.) – Physician Assistant, NPI 1689627069

JOHN DAVID MCDERMOTT (P.A.) is a healthcare provider. based in Boise, Idaho. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials P.A.. They hold a License No. PRA103 (ID). The NPI Number for JOHN DAVID MCDERMOTT (P.A.) is 1689627069

Main info

Male
35 Years Of Experience
Accepts Medicare Assignment
Name
JOHN DAVID MCDERMOTT (P.A.)
NPI
1689627069
Phone
(208) 381-2222
Address
190 E BANNOCK ST
Enumeration Date
18 May 2006
Last Update Date
4 September 2012

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1991 (35 years ago)
PAC ID
2769515170
Group Practice PAC ID
4981878402
Professional Enrollment ID
I20100805000889
Address ID
ID836426352ME520XXRDXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

1,534 PHYSICIAN ASSISTANT in ID

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Provider Addresses for JOHN DAVID MCDERMOTT (P.A.)

  • St. Luke's Boise Medical Center, 190, East Bannock Street, Downtown, Boise, Ada County, Idaho, 83712, United States

    BOISE, ID 837126241

    Phone: (208) 381-2222

    Type: Mailing

  • 3101, East State Street, Eagle, Ada County, Idaho, 83616, United States

    SUITE 2120

    EAGLE, ID 83616

    Phone: (208) 473-3275

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-08-05

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20100805000889IPhysician AssistantIDTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes454323$0
99214Established patient office or other outpatient visit, 30-39 minutes165125$0
99495Transitional care management services for problem of at least moderate complexity1313$0
20610Aspiration and/or injection of fluid from large joint1211$0
93010Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only1212$0
View full utilization report →

Insurance plans in this area (ZIP 83712)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4981878402View full group profile
NameSpecialtyState
Family PracticeME
Internal MedicineID
Family PracticeID
-TX
-OR
Hand SurgeryID
-ID
Nurse PractitionerID
Physician AssistantID
General SurgeryID

Reviews

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Frequently asked questions

What is the standard ID for JOHN DAVID MCDERMOTT (P.A.) in the U.S.?
In the U.S., JOHN DAVID MCDERMOTT (P.A.) is identified by NPI 1689627069.
Does the public listing show JOHN DAVID MCDERMOTT (P.A.) as active?
JOHN DAVID MCDERMOTT (P.A.)'s NPI record reflects an active status in NPPES.
What services align with JOHN DAVID MCDERMOTT (P.A.)'s listing?
JOHN DAVID MCDERMOTT (P.A.)'s public classification highlights Physician Assistant. Clinical services aligned with this taxonomy classification.
Can patients visit JOHN DAVID MCDERMOTT (P.A.) in Boise, Idaho?
For routing, start with Boise, Idaho for JOHN DAVID MCDERMOTT (P.A.), then verify phone and hours locally.
Why is information missing for JOHN DAVID MCDERMOTT (P.A.)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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