Individual provider Active NPI

Heiko Weert De Riese, M.D.

  • Psychiatry Physician
  • Boise, ID
National Provider Identifier
1831621333
Registry record updated Oct 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
M-16773 Issued in ID
Practice address
403 S 11TH St Ste 210
Boise, ID 83702-6968
Phone
(208) 381-6005
Fax
(208) 381-6006
NPI assigned
Apr 3, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X M-16773 ID Primary
Psychiatry Physician 2084P0800X 10964340-1205 UT

Addresses

Primary practice location

403 S 11TH St Ste 210
Boise, ID 83702-6968

Mailing address

190 E Bannock St
Boise, ID 83712-6241

Other practice location 1

501 Chipeta Way
Rm. 1885
Salt Lake City, UT 84108
Phone (801) 581-4096

Other practice location 2

1500 Red River St
Austin, TX 78701-1918
Phone (512) 324-7000

Other practice location 3

703 S Americana Blvd Ste 150
Boise, ID 83702-4976
Phone (208) 706-6375

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
I20221202001847 ID Practitioner - Psychiatry 3971856246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Texas Tech University Health Science Center School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Lukes Clinic-Treasure Valley LLCGroup PAC ID 4981878402, 1,155 clinicians

Practice addresses (Care Compare)

100 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-2983

190 E Bannock St
Boise, ID 83712-6241
Phone (208) 381-9384

403 S 11TH St
Boise, ID 83702-6968

520 S Eagle Rd
Meridian, ID 83642-6351

600 N Robbins Rd
Boise, ID 83702-4565

608 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

610 W Hays St
Boise, ID 83702-5511
Phone (208) 381-5970

9580 W St Lukes Dr
Nampa, ID 83687-7912
Phone (208) 505-2711

9850 St Lukes Dr
Nampa, ID 83687-7912

9850 W St Luke'S Dr
Nampa, ID 83687-7912

Hospital & facility affiliations

  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
  • St Luke'S Nampa Medical Center Hospital, Nampa, ID, CCN 130071

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
81.29
Promoting interoperability
100
Improvement activities
40
Cost
76.37

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-16773IDMDPsychiatry Physician
10964340-1205UTMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Lukes Clinic-Treasure Valley LLC CurrentSince Aug 31, 2022 Accepting new patients

Locations

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

703 S Americana Blvd
Ste 150
Boise, ID 83702
Phone (208) 706-6375

403 S 11th St
Ste 210
Boise, ID 83702
Phone (208) 381-6005

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

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 4

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": "1491177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728432000000",
    "number": "1831621333",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 S 11TH ST STE 210",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026968",
            "telephone_number": "208-381-6005",
            "fax_number": "208-381-6006"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Chipeta Way",
            "address_2": "Rm. 1885",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "84108",
            "country_code": "US",
            "telephone_number": "801-581-4096",
            "fax_number": "801-581-5604",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 Red River St",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787011918",
            "country_code": "US",
            "telephone_number": "512-324-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "703 S Americana Blvd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837024976",
            "country_code": "US",
            "telephone_number": "208-706-6375",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE RIESE",
        "first_name": "HEIKO",
        "middle_name": "WEERT",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-03",
        "last_updated": "2024-10-09",
        "certification_date": "2024-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "ID",
            "license": "M-16773",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "UT",
            "license": "10964340-1205",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.