Individual provider Active NPI

John A Libertino, MD

  • Urology Physician
  • Burlington, MA
National Provider Identifier
1043367097
Registry record updated Jan 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
32219 Issued in MA
Practice address
41 Mall Rd
Burlington, MA 01805-0001
Phone
(781) 744-8000
Fax
(781) 744-5429
NPI assigned
Jan 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 32219 MA Primary

Addresses

Primary practice location

41 Mall Rd
Burlington, MA 01805-0001

Mailing address

41 Mall Rd
Burlington, MA 01805-0001
Phone (781) 744-8000

Other identifiers 1

IdentifierTypeStateIssuer
6166768MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050505001139 MA Practitioner - Urology 4486694718 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
32219MAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emerson Practice Associates, Inc. CurrentSince May 1, 2016 Accepting new patients
Lahey Clinic, Inc. CurrentSince Apr 30, 1970 Accepting new patients
Lahey Clinic, Inc CurrentSince Mar 4, 1998 Accepting new patients

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

133 Ornac
Concord, MA 01742
Phone (978) 287-3000

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
Emerson HospitalConcord, MA, CCN 220084 Hospital Corporate Director Jun 23, 2020
Emerson HospitalConcord, MA, CCN 22S084 Hospital Corporate Director Jun 23, 2020
Emerson Hospital Home Care/HospiceConcord, MA, CCN 227072 Home health agency Corporate Director Jun 23, 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 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.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200614400000",
    "number": "1043367097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MALL RD",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018050001",
            "telephone_number": "781-744-8000",
            "fax_number": "781-744-5429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 MALL RD",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018050001",
            "telephone_number": "781-744-8000",
            "fax_number": "781-744-5429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBERTINO",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-04",
        "last_updated": "2008-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MA",
            "license": "32219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6166768",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, MA

Sources for this page

Verify at the official NPI Registry.