Lisa M. Barker, MD
Individual provider Active NPI Pediatrics Physician · Meridian, ID
NPI 1184636375 · NPPES record last updated Jul 24, 2013
Key facts
- NPI
- 1184636375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- M1628 (ID)
- Practice address
- 1620 S Celebration Ave
Meridian, ID 83642-2779 - Phone
- (208) 884-1030
- NPI assigned
- Aug 13, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111216000358 | ID | Practitioner - Pediatric Medicine | 2567637739 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M1628 | ID | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Lukes Clinic-Treasure Valley LLC | Pediatrics | Current |
Accepting new patients |
| St Lukes Regional Medical Center | Past | Accepting new patients |
Locations
610 W Hays St
Boise, ID 83702
Phone (208) 345-3530
190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378
100 E Idaho St
Ste 401
Boise, ID 83712
Phone (208) 345-0715
1620 S Celebration Ave
Meridian, ID 83642
Phone (208) 884-1030
Interoperability endpoints
- lbarker1726@direct.slhs.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | M1628 | ID | Yes |
Addresses
Primary practice location
1620 S Celebration Ave
Meridian, ID 83642-2779
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2222
Other providers in Meridian, ID
- Patient Ngoy Banza
- Donald Baranco
- David James Barclay II
- Jana Barker
- Jason Curtis Barker
- Adriana N. Barnes
- Carissa Ann Barnes
- James Derek Barnes
- Randy Lee Barnes
- Sarah Barnes
All providers in Meridian, ID · Pediatrics Physician in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.