NPIMap

Individual provider Active NPI

Leonardo B C Brasiliense, MD

  • Neurological Surgery Physician
  • Boise, ID
National Provider Identifier
1689052664
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
M-17423 Issued in ID
Practice address
1072 N Liberty St Ste 200
Boise, ID 83704-8963
Phone
(208) 302-4100
Fax
(208) 302-4135
NPI assigned
May 11, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X MD61270647 WA
Neurological Surgery Physician 207T00000X M-17423 ID Primary

Addresses

Primary practice location

1072 N Liberty St Ste 200
Boise, ID 83704-8963

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 236-7051

Other practice location 1

550 17th Ave Ste 110
Seattle, WA 98122-5789
Phone (206) 320-3470

Other identifiers 1

IdentifierTypeStateIssuer
2213825MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231011003302 ID Practitioner - Neurosurgery 5799037487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

1072 N Liberty St
Boise, ID 83704-8708

3025 W Cherry LN
Meridian, ID 83642-8531

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion26

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD61270647WAMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Alphonsus Regional Medical Center Inc Neurological Surgery Current Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Oct 1, 2023 Accepting new patients
Saint Alphonsus Regional Medical Center Inc CurrentSince Oct 1, 2023 Accepting new patients
Saint Alphonsus Specialty Services Inc Neurological Surgery PastSince Sep 5, 2023 Accepting new patients
Banner University Medical Center Tucson Neurological Surgery Past Accepting new patients

Locations

1072 N Liberty St
Ste 200
Boise, ID 83704
Phone (208) 302-4100

3025 W Cherry Ln
Meridian, ID 83642
Phone (208) 302-6400

3025 W Cherry Ln
Ste B
Meridian, ID 83642
Phone (208) 302-6400

Interoperability endpoints

  • Direct secure messaging: lbrasiliense2902008@direct.trinity-health.org

Organizations & group practices 5

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 10

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": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693440000000",
    "number": "1689052664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-236-7051",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1072 N LIBERTY ST STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048963",
            "telephone_number": "208-302-4100",
            "fax_number": "208-302-4135"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 17th Ave Ste 110",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981225789",
            "country_code": "US",
            "telephone_number": "206-320-3470",
            "fax_number": "206-320-3471",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRASILIENSE",
        "first_name": "LEONARDO",
        "middle_name": "B C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-11",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "WA",
            "license": "MD61270647",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "ID",
            "license": "M-17423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2213825",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.