Individual provider Active NPI

Ilya M Leyngold, MD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Meridian, ID
National Provider Identifier
1407996176
Registry record updated Apr 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X
License
M-15568 Issued in ID
Practice address
3015 E Goldstone Dr # 130
Meridian, ID 83642-1549
Phone
(208) 900-4673
Fax
(208) 266-5033
NPI assigned
Feb 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X M-15568 ID Primary

Addresses

Primary practice location

3015 E Goldstone Dr # 130
Meridian, ID 83642-1549

Mailing address

3015 E Goldstone Dr Ste 130
Meridian, ID 83642-1224
Phone (208) 900-4673

Other practice location 1

3475 Erwin Rd
Durham, NC 27705-0005
Phone (919) 684-4224

Other identifiers 3

IdentifierTypeStateIssuer
14L01OtherFLBLUE CROSS BLUE SHIELD
005984000MedicaidFL
20024216OtherIDMEDICARE

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
I20220405001012 ID Practitioner - Ophthalmology 2860517968 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Johns Hopkins University School of Medicine, 2006
Medicare assignment
May accept Medicare assignment
Group practices
Leyngold Institute for Plastic Surgery PLLCGroup PAC ID 4789079948, 3 clinicians

Practice addresses (Care Compare)

3015 E Goldstone Dr
Suite 130
Meridian, ID 83642-1549

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-15568IDMDOphthalmic Plastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Leyngold Institute for Plastic Surgery PLLC CurrentSince Mar 1, 2022 Accepting new patients
Oculoplastic Surgery, Inc. Ophthalmology PastSince Oct 1, 2023 Accepting new patients
Duke Health Integrated Practice, Inc. Past Accepting new patients

Locations

3015 E Goldstone Dr
Ste 130
Meridian, ID 83642
Phone (208) 900-4673

Interoperability endpoints

  • Direct secure messaging: ileyngold263172@direct.medicine.duke.edu
  • Direct secure messaging: ileyngold1684528@direct.trinity-health.org

Organizations & group practices 3

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 2

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": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775606400000",
    "number": "1407996176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 E GOLDSTONE DR STE 130",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421224",
            "telephone_number": "208-900-4673",
            "fax_number": "208-266-5033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 E GOLDSTONE DR # 130",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421549",
            "telephone_number": "208-900-4673",
            "fax_number": "208-266-5033"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3475 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277050005",
            "country_code": "US",
            "telephone_number": "919-684-4224",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEYNGOLD",
        "first_name": "ILYA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2026-04-08",
        "certification_date": "2026-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "ID",
            "license": "M-15568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "14L01",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005984000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "20024216",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.