Anne A. Idiculla, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

2001010866 Issued in MO

Practice address

802 N Riverside Rd
Suite 260
Saint Joseph, MO 64507-9794

Phone

(816) 271-7673

Fax

(816) 271-4924

NPI assigned

Jun 28, 2006

Last updated

Oct 6, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Anne J. Thomas Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Heartland Regional Medical Center

  dba Mosaic Life Care

  • General Practice Physician
  • Saint Joseph, MO
  • NPI 1477575405

  Physical Medicine & Rehabilitation

  NPD (past)
• Midwestern Health Management, Inc.

  • Family Medicine Physician
  • Saint Joseph, MO
  • NPI 1104962901
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507248000000",
    "number": "1114954559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 N RIVERSIDE RD",
            "address_2": "SUITE 130",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072502",
            "telephone_number": "816-271-7673",
            "fax_number": "816-271-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N RIVERSIDE RD",
            "address_2": "SUITE 260",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645079794",
            "telephone_number": "816-271-7673",
            "fax_number": "816-271-4924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDICULLA",
        "first_name": "ANNE",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-28",
        "last_updated": "2017-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MO",
            "license": "2001010866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNE",
            "last_name": "THOMAS",
            "middle_name": "J.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Seung Hoon Hwang
• Hy-Vee Inc (Hy-Vee Pharmacy (1552))
• Emily Rene Hyatt
• I-Care Rides
• Uchechi Genevieve Ibe, MD
• Image Specialties, L.L.C.
• Marsha Ann Ingersoll
• Chelsea Renea Ingino, FNP-BC
• Insight Eyecare Specialties Inc
• Interfaith Community Services, Inc.

• Physical Medicine & Rehabilitation Physician in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Physical Medicine & Rehabilitation Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.