NPIMap

Individual provider Active NPI

David Redford Liljenquist, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Idaho Falls, ID
National Provider Identifier
1932109931
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
M9285 Issued in ID
Practice address
3910 Washington Parkway
Idaho Falls, ID 83404-7596
Phone
(208) 523-1122
Fax
(208) 523-2582
NPI assigned
Aug 1, 2005
Last updated
Sep 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X M9285 ID Primary

Addresses

Primary practice location

3910 Washington Parkway
Idaho Falls, ID 83404-7596

Mailing address

3910 Washington Parkway
Idaho Falls, ID 83404-7596
Phone (208) 523-1122

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
I20050823000476 ID Practitioner - EndocrinologyPractitioner - Internal Medicine 4587695218 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
George Washington University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rocky Mountain Diabetes and Osteoporosis Center PAGroup PAC ID 5890750483, 15 clinicians

Practice addresses (Care Compare)

3910 Washington Pkwy
Idaho Falls, ID 83404-7596
Phone (208) 523-1122

3910 Washington Pkwy
Idaho Falls, ID 83404-7883

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M9285IDMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rocky Mountain Diabetes and Osteoporosis Center PA Endocrinology, Diabetes & Metabolism CurrentSince Jul 1, 2005 Accepting new patients
RM Lab LLC CurrentSince Aug 1, 1999 Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients
Rocky Mountain Pharmacy, LLC PastSince Jul 12, 2019 Accepting new patients

Locations

2220 E 25th St
Idaho Falls, ID 83404
Phone (208) 523-1122

3910 Washington Pkwy
Idaho Falls, ID 83404
Phone (208) 522-2996

Interoperability endpoints

  • Direct secure messaging: david.liljenquist.1@33233.direct.athenahealth.com
  • Direct secure messaging: david.liljenquist@rmdoc.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/FEFDAA

Organizations & group practices 4

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.

Hospital & facility affiliations 8

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": "1122854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1932109931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 WASHINGTON PARKWAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047596",
            "telephone_number": "208-523-1122",
            "fax_number": "208-523-2582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 WASHINGTON PARKWAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047596",
            "telephone_number": "208-523-1122",
            "fax_number": "208-523-2582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILJENQUIST",
        "first_name": "DAVID",
        "middle_name": "REDFORD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-01",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "ID",
            "license": "M9285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

Verify at the official NPI Registry.