NPIMap

Individual provider Active NPI

Otto Liebmann, MD

  • Emergency Medicine Physician
  • Providence, RI
National Provider Identifier
1023039146
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD12526 Issued in RI
Practice address
593 Eddy St
Claverick 2
Providence, RI 02903-4923
Phone
(401) 519-1604
Fax
(401) 272-0538
NPI assigned
Jul 22, 2006
Last updated
Aug 31, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD12526 RI Primary

Addresses

Primary practice location

593 Eddy St
Claverick 2
Providence, RI 02903-4923

Mailing address

125 Whipple St Ste 3
Providence, RI 02908-3258
Phone (401) 519-0337

Other identifiers 9

IdentifierTypeStateIssuer
12/13/2007OtherRINHPRI
939025129OtherRIMEDICARE GROUP NUMBER
007059786OtherRIRI MEDICARE
1/27/2009OtherMATUFTS HEALTH PLAN
2145464MedicaidRI
414642OtherRIBCBSRI
P00671205OtherRAILROAD MEDICARE
1023039146OtherRINPI
2145464MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20080103000684 RI Practitioner - Emergency Medicine 2668477829 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
New York University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians
Brown Emergency MedicineGroup PAC ID 7214833169, 140 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-7024

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.45 of 100Reported as group
Quality
85.46
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD12526RIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. Emergency Medicine CurrentSince Feb 1, 2026 Accepting new patients
Lifespan Physician Group Inc CurrentSince Feb 1, 2026 Accepting new patients
Lifespan Corporation Current Accepting new patients
Brown Emergency Medicine Emergency Medicine CurrentSince Oct 12, 2007 Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

125 Whipple St
Ste 3
Providence, RI 02908
Phone (401) 854-2504

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

593 Eddy St
Providence, RI 02903

593 Eddy St
#2
Providence, RI 02903
Phone (401) 519-1604

Interoperability endpoints

  • Direct secure messaging: oliebmann15379@brownhealth.medalliesdirect.net

Organizations & group practices 5

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 5

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": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1023039146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WHIPPLE ST STE 3",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029083258",
            "telephone_number": "401-519-0337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "CLAVERICK 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-519-1604",
            "fax_number": "401-272-0538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBMANN",
        "first_name": "OTTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "RI",
            "license": "MD12526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NHPRI",
            "identifier": "12/13/2007",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "939025129",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RI MEDICARE",
            "identifier": "007059786",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "1/27/2009",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2145464",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSRI",
            "identifier": "414642",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00671205",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1023039146",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2145464",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.