A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer,...
ID license #M-13462VA license #0101247286taxonomy 207R00000X
Identifiers
Type
Value
Notes
05 (VA)
1003079120
01 (VA)
PAR
CORVEL/CORCARE
01 (VA)
PAR
CIGNA
01 (VA)
PAR
VA HEALTH NETWORK
01 (VA)
10060934
OPTIMA HEALTH
01 (VA)
407988
ANTHEM BC/BS
01 (VA)
PAR
VA PREMIER HEALTH
01 (VA)
-028
TRICARE/CHAMPUS
01 (VA)
PAR
MULTIPLAN
01 (VA)
PAR
AETNA
01 (VA)
PAR
FIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
05 (NC)
5915448
01 (VA)
PAR
USA MANAGED CARE
01 (VA)
PAR
UNITED HEALTH CARE/MAMSI
Multi-state credentialing: Licensed in 2 states. Useful context for credentialers building cross-state provider networks.
Medicare directory context
Attributes below come from the CMS Doctors & Clinicians dataset used by Medicare Care Compare,
retrieved 2026-10-12. They apply only to this clinician's public Medicare listing.
Medicare specialties
Hospitalist
Plus 2 additional
Medical school
Eastern Virginia Medical School
Graduation year 2007
Largest Medicare group
672 members
Largest listed enrollment group
Facility affiliations reported by CMS
Saint Alphonsus Regional Medical Center Inc
Medicare listing data does not guarantee that a clinician is accepting new patients or that a service is covered.
View the CMS dataset →
Practice context
Part of a multi-provider practice. 31 other active providers share this practice address in NPPES.
Recently enumerated nearby: 1 new internal medicine provider has been added in Boise in the last 180 days.
See all →
Provyx · Custom healthcare lists
Need all 512 Internal Medicine providers in Idaho?
Get the full list as a CSV with verified work emails, direct phones, and LinkedIn URLs.