NPIMap

Individual provider Active NPI

Liberty Lomeli, PA-C

  • Physician Assistant
  • Porterville, CA
National Provider Identifier
1003860453
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15082 Issued in CA
Practice address
1107 West Poplar Ave.
Porterville, CA 93257-5839
Phone
(559) 781-7242
Fax
(559) 793-3542
NPI assigned
May 20, 2006
Last updated
Nov 1, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA15082 CA Primary

Addresses

Primary practice location

1107 West Poplar Ave.
Porterville, CA 93257-5839

Mailing address

305 East Center Avenue
Visalia, CA 93291-6331
Phone (559) 734-4700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20101011000406 CA Practitioner - Physician Assistant 4486846342 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Stanford University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
La Laser Center PC a Professional Medical CorporationGroup PAC ID 9537181185, 81 clinicians

Practice addresses (Care Compare)

1025 N Demaree St
Visalia, CA 93291-4117
Phone (559) 931-0800

144 S L St
Tulare, CA 93274-4104
Phone (559) 890-3150

876 W Grand Ave
Porterville, CA 93257-2071
Phone (951) 412-1540

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA15082CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network CurrentSince Aug 20, 2015 Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network Current Accepting new patients
Family Healthcare Network CurrentSince Aug 20, 2015 Accepting new patients

Locations

1107 W Poplar Ave
Porterville, CA 93257
Phone (559) 781-7242

305 E Center Ave
Visalia, CA 93291
Phone (559) 737-4792

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CCECCA
  • Direct secure messaging: lomeli@lalasercenter.emadirect.md

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sierra View Medical CenterPorterville, CA, CCN 050261 Hospital Corporate Director Dec 15, 2020
Sierra View Medical CenterPorterville, CA, CCN 555766 Skilled nursing facility Managing Control - Governing Body
Trustee of the SNF		 Dec 15, 2020
Dec 15, 2020
Sierra View Community Health Center - Terra BellaTerra Bella, CA, CCN 058723 Rural health clinic Corporate Director Dec 15, 2020

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1003860453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 EAST CENTER AVENUE",
            "city": "VISALIA",
            "state": "CA",
            "postal_code": "932916331",
            "telephone_number": "559-734-4700",
            "fax_number": "559-734-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 WEST POPLAR AVE.",
            "city": "PORTERVILLE",
            "state": "CA",
            "postal_code": "932575839",
            "telephone_number": "559-781-7242",
            "fax_number": "559-793-3542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOMELI",
        "first_name": "LIBERTY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Porterville, CA

Sources for this page

Verify at the official NPI Registry.