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MATT WRATHALL CM
NPI 1205612405
Clinic/Center - Pain in Rexburg, ID

Active since September 04, 2023PECOS Enrolled
663 TREJO ST, REXBURG, ID 83440(385) 758-4356 Get Directions Write a Review

NPPES record last updated: March 16, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 16, 2025, Sep 4, 2023 (2 updates tracked since 2023).

About Matt Wrathall Cm NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MATT WRATHALL CM (NPI 1205612405) is an individual pain provider in Rexburg, Idaho and active in the NPI registry since September 2023. He is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1205612405
Entity TypeIndividualMale
Primary Taxonomy261QP3300X
Provider Legal NameMATT WRATHALLCredential: CM
Location Address663 TREJO STRexburg, ID 83440-2579
Mailing AddressPo Box 151Menan, ID 83434-0151 · (385) 758-4356
Phone(385) 758-4356
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateSeptember 4, 2023
Last NPPES UpdateMarch 16, 20252 updates tracked since enumeration
NPPES CertifiedMarch 16, 2025
✔ NPI 1205612405 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · PainAmbulatory Health Care Facilities
Taxonomy Code261QP3300X
663 TREJO ST, Rexburg, ID 83440
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Matt Wrathall Cm is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3274016266
PECOS Enrollment IDI20260309000448
Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 83440 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$160.17 typical visit price
range $52.44 – $160.17
Typical copayment $40.04 (range $13.11 – $40.04)
Most-billed visit code 99205
Established Patient
$93.26 typical visit price
range $16.68 – $130.93
Typical copayment $23.31 (range $4.17 – $32.73)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Matt Wrathall's NPI number?

The NPI number for Matt Wrathall is 1205612405. It was assigned to this individual provider in the NPPES registry on September 4, 2023.

Where is Matt Wrathall located?

Matt Wrathall practices at 663 Trejo St, Rexburg, ID 83440. The listed phone number is (385) 758-4356.

What is Matt Wrathall's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Pain, with taxonomy code 261QP3300X.

Is Matt Wrathall enrolled in Medicare?

Yes. Matt Wrathall is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Matt Wrathall was last updated on March 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.