Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Michael Allan Hallstrom, PA-C

Individual provider Physician Assistant · NPI 1972950210

Michael Allan Hallstrom, PA-C is a Physician Assistant in Boise, Idaho. Qualified in 2017, 9 years ago. Practices with St Lukes Clinic-Treasure Valley LLC, a 1,150-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
9
Licensed in
ID
In the registry since
2016
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

190 E Bannock St
Boise, ID 83712-6241
Phone: (208) 381-5015
Fax: (208) 381-1873
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 520 S Eagle Rd, Meridian, ID 83642-6351 — (208) 381-5015

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (ID)

Record details

NPI number1972950210
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 17, 2016
Last updated in NPPESMarch 17, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice St Lukes Clinic-Treasure Valley Llc — 1150 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations7 on file with Medicare

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