NPI age
17 years
Enumerated 2009-04-29
● Active Type 2 · Organization
Subpart
Michael R Dibenedetto MD Pllc
Michael R Dibenedetto MD Pllc is 1 of 24 surgery organizations in Idaho.
Primary specialty
Surgery
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Brosnahan
Office Manager
Last NPPES update
2009-10-21
Source: monthly bulk 2026-05
How this organization compares
Across 24 active surgery providers in Idaho.
NPI age
17 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
0
NPI lifetime · 2009 → 2026
2009-04Enumerated in NPPES
2009
2026
Where they practice
Primary practice location
30544 Highway 200, Suite 102
Ponderay, ID 838525005
Mailing address
30544 Highway 200, Suite 102
Ponderay, ID 838525005
Authorized official
Wendy S Brosnahan
Office Manager
📞 2082635900
Individual providers at this organization
7 individual providers on file at this primary practice address.
- Joan Bloom, M.D. Family Medicine NPI 1033229307
- Angela Chapin, MT Massage Therapist NPI 1679110845
- Bruce Demko, CRNA Nurse Anesthetist, Certified Registered NPI 1780651539
- Michael Dibenedetto, M.D. Orthopaedic Surgery NPI 1679644397
- Jonathan Fisher, DPM Podiatrist NPI 1891969606
- Tara Heisey, LMT Massage Therapist NPI 1245194059
- Jessica Hunt, LMT Massage Therapist NPI 1851894018
Specialties
-
Surgery PrimaryA surgeon who specializes in plastic and reconstructive surgery.
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | DG3627 | RAIL ROAD MEDICARE |
| 01 (ID) | 8N834 | BLUE CROSS |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
Seasons Plastic & Reconstructive Surgery
Practice context
Multi-provider organization. 7 individual providers on file at this primary address.
Subpart of Michael R Dibenedetto MD Pllc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.