Kimberly Ann Licciardi, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

14856 Issued in NH

Practice address

764 2ND St
Manchester, NH 03102-5210

Phone

(603) 669-3925

NPI assigned

Jan 12, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Kimberly Ann Truax Former name

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

State University of New York at Buffalo School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elliot Professional ServicesGroup PAC ID 6103727920, 429 clinicians

NH Eye Associates PLLCGroup PAC ID 6608849823, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Elliot Hospital Hospital, Manchester, NH, CCN 300012

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elliot Professional Services

  • Internal Medicine Physician
  • Manchester, NH
  • NPI 1285627935
  Medicare reassignment Care Compare group NPD
• NH Eye Associates PLLC

  • Ophthalmology Physician
  • Manchester, NH
  • NPI 1518044213
  Medicare reassignment Care Compare group NPD
• Amoskeag Health

  • Federally Qualified Health Center (FQHC)
  • Manchester, NH
  • NPI 1225625643
  NPD (past)
• Pinnacle Rehabilitation Network LLC

  • Physical Therapist
  • Freeport, ME
  • NPI 1235940388
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Elliot Hospital of the City of Manchester

  • General Acute Care Hospital
  • Manchester, NH
  • NPI 1902996028
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720396800000",
    "number": "1104976885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 2ND ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031025210",
            "telephone_number": "603-669-3925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "764 2ND ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031025210",
            "telephone_number": "603-669-3925"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Buttrick Rd Ste C3",
            "address_purpose": "LOCATION",
            "city": "Londonderry",
            "state": "NH",
            "postal_code": "030533353",
            "country_code": "US",
            "telephone_number": "603-432-8801",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICCIARDI",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-12",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT188086",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NH",
            "license": "14856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "TRUAX",
            "middle_name": "ANN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Geng Li, M.D., PH.D.
• Kathryne Libbra, BCBA
• Douglas L Libby, PHARM.D.
• Kristen Es Libby, LICSW
• Shannon Kristina Libby, MSW
• Licensed Support Corp
• Carol Liddell, RNC, MS
• Gabriele Lieberg, MD
• Joseph John Lienert, M.D.
• Lifeshare Management Group, Inc.

• Ophthalmology Physician in Manchester, NH
• Providers in Manchester, NH by specialty
• Ophthalmology Physician in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.