Anthony Liccini

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M-16632 Issued in ID

Practice address

305 E Jefferson St
Boise, ID 83712-6231

Phone

(208) 345-0715

NPI assigned

Mar 27, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

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

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.

• St Lukes Clinic-Treasure Valley LLC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1326336058

  Pediatrics

  Medicare reassignment NPD
• St Lukes Regional Medical Center

  • General Acute Care Hospital
  • Boise, ID
  • NPI 1770586794
  NPD (past)

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660867200000",
    "number": "1225569551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 E BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126241",
            "telephone_number": "208-381-8752",
            "fax_number": "509-865-5783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 E JEFFERSON ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126231",
            "telephone_number": "208-345-0715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 W 1st Ave",
            "address_purpose": "LOCATION",
            "city": "Toppenish",
            "state": "WA",
            "postal_code": "989481564",
            "country_code": "US",
            "telephone_number": "509-865-5600",
            "fax_number": "509-865-5783",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICCINI",
        "first_name": "ANTHONY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD61058990",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-16632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aliccini34089@yvfwc.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "YVFWC Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "510 W 1st Ave",
            "city": "Toppenish",
            "state": "WA",
            "country_code": "US",
            "postal_code": "989481564",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lgcounseling LLC
• Brandon Lheureux, BS
• Linhai Li, L.AC.
• Henry Liao
• James Liaw
• Heather Dawn Liddell, RDN, LD
• Winston Lie, MD
• Patrick Liebel, M.D.
• Kristina Leeann Liebenthal, FNP-C
• Kelly Jone Liera, PHARMACY TECHNICIAN

• Pediatrics Physician in Boise, ID
• Providers in Boise, ID by specialty
• Pediatrics Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.