NPI age
3 years
Enumerated 2022-08-29
● Active
Type 1 · Individual
Matthew Wade Black, PA
Black is 1 of 3 physician assistant providers in Grangeville and 1 of 387 in Idaho.
Primary specialty
Physician Assistant
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2023-10-25
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 387 active physician assistant providers in Idaho.
NPI age
3 years
↓ 12 yr below median (15 yr)
State licenses
1 state
16% of peers hold multiple states
Subspecialties
0
30% of peers hold subspecialties
NPI lifetime · 2022 → 2026
2022-08Enumerated in NPPES
2022
2026
Where they practice
Practice location
607 W Main St
Grangeville, ID 835301345
Mailing address
607 W Main St
Grangeville, ID 835301345
Additional practice locations
1 secondary location on file with NPPES.
Location 2
22 N Main St
Kooskia, ID 83539
Specialties
-
Physician Assistant PrimaryDefinition to come...
Practice context
Part of a multi-provider practice. 28 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.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.