Calley A. Lidle, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

51175 Issued in MN

Practice address

233 Grand Avenue
St. Paul, MN 55102-9658

Phone

(651) 227-7806

Fax

(651) 256-6707

NPI assigned

May 3, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Calley A. Kennedy Former name

Medicare fee-for-service enrollment

Enrolled in MN

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: clidle629829@fairview.direct-ci.com

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.

• Healtheast Medical Research Institute

  • Clinic/Center
  • Vadnais Heights, MN
  • NPI 1639125503
  Medicare reassignment NPD
• Healtheast Medical Research Institute

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1508191552
  NPD
• Healtheast Medical Research Institute

  • Clinic/Center
  • Woodbury, MN
  • NPI 1831145705
  NPD
• Healtheast Medical Research Institute

  • Clinic/Center
  • Oakdale, MN
  • NPI 1073569935
  NPD (past)
• Healtheast St. John'S Hospital

  • General Acute Care Hospital
  • Maplewood, MN
  • NPI 1447218482
  NPD (past)
• Healtheast Woodwinds Hospital

  • General Acute Care Hospital
  • Woodbury, MN
  • NPI 1356309322
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246492800000",
    "number": "1851513436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 GRAND AVENUE",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "551029658",
            "telephone_number": "651-227-7806",
            "fax_number": "651-256-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 GRAND AVENUE",
            "city": "ST. PAUL",
            "state": "MN",
            "postal_code": "551029658",
            "telephone_number": "651-227-7806",
            "fax_number": "651-256-6707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDLE",
        "first_name": "CALLEY",
        "middle_name": "A.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2009-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "125050402",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "51175",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "52074-020",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185153436",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CALLEY",
            "last_name": "KENNEDY",
            "middle_name": "A.",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Libby, PA-C
• Kayla Libby, DDS
• Sarah Ann Licari, LADC
• Kristy Jordan Lichtenberg, PA
• Rebekah Lichty
• Evan Fredrick Lieberman, LADC, LGSW
• Anthony Liebhard, M.D.
• Heather Ann Liebswager, LPCC
• Faith Lorraine Liedholm Matsch Hicks, NP
• Hope Diane Lien, BD

• Pediatrics Physician in St. Paul, MN
• Providers in St. Paul, MN by specialty
• Pediatrics Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; 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.