Active NPI
Louis Samuels Libby, MD
- Pulmonary Disease Physician
- Portland, OR
National Provider Identifier
1003808486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- License
- MD14297
- Practice address
- 1111 NE 99TH Ave
Suite 200
Portland, OR 97220-9428 - Phone
- (503) 963-3030
- Fax
- (503) 963-3140
- NPI assigned
- Aug 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician | 207RP1001X | MD14297 | OR | Primary |
Addresses
Primary practice location
1111 NE 99TH Ave
Suite 200
Portland, OR 97220-9428
Mailing address
847 NE 19TH Ave
Suite 300
Portland, OR 97232-2684
Phone (503) 963-2801
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 124487 | Medicaid | OR | |
| 1003912 | Medicaid | WA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | referringpulm@orclinic.direct-ci.net | The Oregon Clinic PC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637020800000",
"number": "1003808486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "847 NE 19TH AVE",
"address_2": "SUITE 300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972322684",
"telephone_number": "503-963-2801",
"fax_number": "503-963-2825"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1111 NE 99TH AVE",
"address_2": "SUITE 200",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972209428",
"telephone_number": "503-963-3030",
"fax_number": "503-963-3140"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBBY",
"first_name": "LOUIS",
"middle_name": "SAMUELS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-22",
"last_updated": "2021-11-16",
"certification_date": "2021-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RP1001X",
"taxonomy_group": "",
"desc": "Internal Medicine, Pulmonary Disease",
"state": "OR",
"license": "MD14297",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "124487",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1003912",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "referringpulm@orclinic.direct-ci.net",
"affiliation": "Y",
"affiliationName": "The Oregon Clinic PC",
"address_1": "1111 NE 99th Ave",
"address_2": "Suite 200",
"city": "Portland",
"state": "OR",
"country_code": "US",
"postal_code": "972209428",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.