JOHN CLARK MAYBERRY MD
NPI 1528074077
Surgery in Caldwell, ID
About John Clark Mayberry Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JOHN CLARK MAYBERRY MD (NPI 1528074077) is an individual surgery provider in Caldwell, Idaho, licensed in Idaho (M-12108) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS, is affiliated with Pine Ridge Ihs Hospital, and is a graduate of Oregon Health Sciences University School Of Medicine (1986).
NPPES Registry Identity
Specialties & Licenses 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
John Clark Mayberry Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
4Medicare enrollment records show John Mayberry reassigns Medicare billing to 4 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Ketchum, ID 83340
- Reassigned Medicare billing, Idaho enrollment
- 74 clinicians in this Medicare group
San Rafael, CA 94903
- Reassigned Medicare billing, California enrollment
- 204 clinicians in this Medicare group
Pine Ridge, SD 57770
- Reassigned Medicare billing, Texas enrollment
- 426 clinicians in this Medicare group
San Diego, CA 92123
- Reassigned Medicare billing, California enrollment
- 1,437 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Hospital Affiliations CMS Care Compare
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Pine Ridge Ihs Hospital
Acute Care Hospitals · Pine Ridge, SDPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 83605 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 2
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
CALDWELL, ID 83605
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 John Mayberry's NPI number?
The NPI number for John Mayberry is 1528074077. It was assigned to this individual provider in the NPPES registry on August 1, 2006.
Where is John Mayberry located?
John Mayberry practices at 1906 Fairview Ave Ste 130, Caldwell, ID 83605. The listed phone number is (208) 453-4260.
What is John Mayberry's specialty?
The primary specialty registered for this NPI is Surgery with taxonomy code 208600000X.
Is John Mayberry enrolled in Medicare?
Yes. John Mayberry is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for John Mayberry's services?
According to the CMS Revalidation Reassignment List (October 2026 release), John Mayberry reassigns Medicare benefits to 4 organizations: St Lukes Clinic - Wood River LLC (Ketchum, ID), Knd Development 59, LLC (San Rafael, CA), Pine Ridge Indian Health Service Hospital (Pine Ridge, SD) and Emergency And Acute Care Medical Corporation (San Diego, CA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for John Mayberry's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is John Mayberry affiliated with any hospitals?
According to CMS data, John Mayberry is affiliated with Pine Ridge Ihs Hospital.
When was this NPI record last updated?
The NPPES record for John Mayberry was last updated on October 3, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years 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.
# John Clark Mayberry, MD · NPI 1528074077
Surgery physician in Caldwell, Idaho. Individual provider, active in the CMS NPPES registry since August 1, 2006.
## Identity
- **NPI:** 1528074077 (Entity type: Individual)
- **Enumerated:** August 1, 2006
- **Primary specialty:** Surgery · taxonomy 208600000X
- **State license:** M-12108 (Idaho)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1906 FAIRVIEW AVE STE 130, Caldwell, ID 83605-5433
- **Phone:** (208) 453-4260 · **Fax:** (844) 213-3678
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 4 organizations under Medicare reassignment (form CMS-855R): St Lukes Clinic - Wood River LLC (NPI 1972891604, Ketchum, ID); Knd Development 59, LLC (NPI 1891146866, San Rafael, CA); Pine Ridge Indian Health Service Hospital (NPI 1497786412, Pine Ridge, SD); Emergency And Acute Care Medical Corporation (NPI 1437103942, San Diego, CA) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Oregon Health Sciences University School Of Medicine, class of 1986
## Record status
- **NPPES last updated:** October 3, 2023
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Source: [NPI Profile](https://npiprofile.com/npi/1528074077) · Data from the CMS NPPES public registry.