Andrew Benjamin Vizcarra, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

M-17696 Issued in ID

Practice address

810 Sixth Ave
Sandpoint, ID 83864-5396

Phone

(208) 263-7101

NPI assigned

Apr 19, 2017

Last updated

Apr 23, 2024By the provider in NPPES

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

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

Interoperability endpoints

• Direct secure messaging: andrew.vizcarra.1@32745.direct.athenahealth.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Boundary Regional Community Health Center, Inc.

  dba Kaniksu Community Health

  • Federally Qualified Health Center (FQHC)
  • Priest River, ID
  • NPI 1538447727
  Medicare reassignment NPD
• Boundary Regional Community Health Center Inc

  dba Kaniksu Community Health

  • Community/Retail Pharmacy
  • Sandpoint, ID
  • NPI 1780349241
  NPD
• Boundary Regional Community Health Center, Inc.

  dba Kaniksu Community Health

  • Federally Qualified Health Center (FQHC)
  • Sandpoint, ID
  • NPI 1316343320

  Pediatrics

  NPD
• Boundary Regional Community Health Center Inc

  dba Kaniksu Community Health

  • Federally Qualified Health Center (FQHC)
  • Bonners Ferry, ID
  • NPI 1306883244
  NPD (past)

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713830400000",
    "number": "1629502265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 CEDAR ST STE 206",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838641425",
            "telephone_number": "208-637-1012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 SIXTH AVE",
            "city": "SANDPOINT",
            "state": "ID",
            "postal_code": "838645396",
            "telephone_number": "208-263-7101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIZCARRA",
        "first_name": "ANDREW",
        "middle_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-19",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "60530",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ID",
            "license": "M-17696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harry Ralph Vanderwal Jr., MD
• Joseph Anthony Velazquez, LMFT
• Kimberley Lorraine Velazquez, MSW
• Henry L Verdugo, LCSW
• Viva Enterprises (Sandpoint Optometry & Thomas M Wiley OD)
• Tara Leigh Weeks Vizcarra, M.D.
• Attea Voigt
• Karen Elizabeth Vollmer-Poseley, LPC
• Marc Vroman, LMT
• Maria Christine Walden, ANLC IBCLC BSL BSN

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.