Active NPI
Ethan Scott Lieberman, MD
- Internal Medicine Physician
- Ventura, CA
National Provider Identifier
1013650951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 0116036266
- Practice address
- 147 N Brent St
Ventura, CA 93003-2809 - Phone
- (818) 719-2706
- NPI assigned
- Apr 19, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 0116036266 | VA | Primary |
Addresses
Primary practice location
147 N Brent St
Ventura, CA 93003-2809
Mailing address
PO Box 980257
Richmond, VA 23298-0257
Phone (804) 828-9783
Other practice location 1
VCUHS Department of Internal Medicine Residency
1250 E. Marshall Street
Richmond, VA 23298-0257
Phone (804) 828-9783
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Hospitalist
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
888 S Hill Rd
Ventura, CA 93003-8400
Phone (805) 477-6400
Hospital & facility affiliations
- Community Memorial Hospital - Ventura
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Permanente Medical Group | Current | Accepting new patients | |
| Southern California Permanente Medical Group | Current | Accepting new patients |
Locations
888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400
5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000
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.
-
- Health Maintenance Organization
- Baldwin Park, CA
- NPI 1770515280
-
- Health Maintenance Organization
- Santa Clarita, CA
- NPI 1316409410
-
- Health Maintenance Organization
- Woodland Hills, CA
- NPI 1952333478
Hospital & facility affiliations 10
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ventura, CA
- NPI 1215903018
-
- Multi-Specialty Clinic/Center
- Port Hueneme, CA
- NPI 1659656775
Hospital
-
- Orthopaedic Surgery Physician
- Camarillo, CA
- NPI 1871919126
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1650326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754956800000",
"number": "1013650951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 980257",
"city": "RICHMOND",
"state": "VA",
"postal_code": "232980257",
"telephone_number": "804-828-9783"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "147 N BRENT ST",
"city": "VENTURA",
"state": "CA",
"postal_code": "930032809",
"telephone_number": "818-719-2706"
}
],
"practiceLocations": [
{
"address_1": "VCUHS Department of Internal Medicine Residency",
"address_2": "1250 E. Marshall Street",
"address_purpose": "LOCATION",
"city": "Richmond",
"state": "VA",
"postal_code": "232980257",
"country_code": "US",
"telephone_number": "804-828-9783",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LIEBERMAN",
"first_name": "ETHAN",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-04-19",
"last_updated": "2025-08-12",
"certification_date": "2025-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "VA",
"license": "0116036266",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ventura, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.