Individual provider Active NPI

Timothy Morris Deblieck, M.D.

  • Family Medicine Physician
  • Boise, ID
National Provider Identifier
1114961042
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-7182 Issued in ID
Practice address
777 N Raymond St
Boise, ID 83704-9251
Phone
(208) 514-2500
Fax
(208) 375-2217
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-7182 ID Primary

Addresses

Primary practice location

777 N Raymond St
Boise, ID 83704-9251

Mailing address

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 367-6030

Other identifiers 1

IdentifierTypeStateIssuer
1114961042MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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

Enrollment IDStateProvider typePAC IDDetails
I20070926000718 ID Practitioner - Family Practice 8123113834 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Washington University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Full Circle Health IncGroup PAC ID 6709986797, 106 clinicians

Practice addresses (Care Compare)

777 N Raymond St
Boise, ID 83704-9251
Phone (208) 514-2500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-7182IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Full Circle Health, Inc. CurrentSince Jan 11, 2011 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients

Locations

6565 W Emerald St
Boise, ID 83704
Phone (208) 377-5055

325 W Idaho St
Boise, ID 83702
Phone (208) 514-2525

777 N Raymond St
Boise, ID 83704
Phone (208) 367-6030

215 W 35th St
Garden City, ID 83714
Phone (208) 384-5200

2275 S Eagle Rd
Ste 120
Meridian, ID 83642
Phone (208) 514-2520

Interoperability endpoints

  • Direct secure messaging: tdeblieck295104@direct.ochin.org

Organizations & group practices 2

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.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1114961042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-367-6030",
            "fax_number": "208-367-6123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N RAYMOND ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837049251",
            "telephone_number": "208-514-2500",
            "fax_number": "208-375-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEBLIECK",
        "first_name": "TIMOTHY",
        "middle_name": "MORRIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-7182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114961042",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.