Jan Deblieck MD PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

M7045 Issued in ID

Legal business name

JAN DEBLIECK MD PA

Doing business as

DeBlieck Dermatology

Practice address

13176 W Persimmon LN
Boise, ID 83713-1986

Phone

(208) 939-5030

Fax

(208) 939-1892

NPI assigned

May 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer Deblieck, M.D.NPI 1861421240

Title

Physician-Owner

Phone

(208) 939-5030

Specialties & licenses 1

Addresses

Other names 1

• DeBlieck Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Ann Deblieck, MD

  • Dermatology Physician
  • Boise, ID
  • NPI 1861421240
  Medicare reassignment NPD Authorized official
• Nicholas Blickenstaff, M.D., M.S.

  • Dermatology Physician
  • Boise, ID
  • NPI 1437544582

  Single Specialty

  NPD (past)
• Jhon R Hall, MD

  • Dermatology Physician
  • Boise, ID
  • NPI 1225107386
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1497960983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13176 W PERSIMMON LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-939-5030",
            "fax_number": "208-939-1892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13176 W PERSIMMON LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131986",
            "telephone_number": "208-939-5030",
            "fax_number": "208-939-1892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAN DEBLIECK MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "DEBLIECK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PHYSICIAN-OWNER",
        "authorized_official_telephone_number": "208-939-5030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "ID",
            "license": "M7045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeBlieck Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James W. Kranz NMD, LLC
• Barbara Elizabeth James, PH.D.
• Alicia D Jamieson
• Jamii Health Services, LLC
• Haley Jamtgaard
• Ashlee Jane, NMD
• Janelle Stauffer LCSW PLLC
• Janelle Stauffer, LCSW PLLC
• Danielle Janes, DPT
• Denise Louise Janicek, CRNA

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.