NPI age
19 years
Enumerated 2006-07-06
● Active
Type 1 · Individual
Matthew J Fackrell, DO
Fackrell is 1 of 21 family medicine providers in Blackfoot and 1 of 1691 in Idaho.
Primary specialty
Family Medicine
Plus 3 subspecialties
Licensed in
CO, WA, OR, PA
4 states
Status
Active
No deactivations on record
Last NPPES update
2024-10-22
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1691 active family medicine providers in Idaho.
NPI age
19 years
↑ 2 yr above median (17 yr)
State licenses
4 states
Top 85% — 14% of peers are multi-state
Subspecialties
0
31% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-07Enumerated in NPPES
2006
2026
Where they practice
Practice location
1441 Parkway Dr
Blackfoot, ID 832211667
Mailing address
1441 Parkway Dr
Blackfoot, ID 832211667
Additional practice locations
2 secondary locations on file with NPPES.
Location 2
13741 E Rice Pl Ste 101
Aurora, CO 800151082
Location 3
11417 124th Ave Ne Ste 100
Kirkland, WA 980334677
Specialties
-
Family Medicine PrimaryFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 1374716 | PTAN |
| 05 (ID) | 807815500 |
Multi-state credentialing: Licensed in 4 states. Useful context for credentialers building cross-state provider networks.
Practice context
Part of a multi-provider practice. 35 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
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