Individual provider Active NPI

Gabriel Alexander Liboiron-Cohen, AU.D.

  • Audiologist
  • Berkeley, CA
National Provider Identifier
1164257697
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AU3952 Issued in CA
Practice address
2748 San Pablo Ave
Berkeley, CA 94702-2240
Phone
(510) 841-0681
NPI assigned
Sep 4, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X
Audiologist 231H00000X AU3952 CA Primary

Addresses

Primary practice location

2748 San Pablo Ave
Berkeley, CA 94702-2240

Mailing address

2748 San Pablo Ave
Berkeley, CA 94702-2240
Phone (510) 841-0681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241216002111 CA Practitioner - Qualified Audiologist 3274069133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Berkeley Hearing Center LLCGroup PAC ID 2961895453, 4 clinicians

Practice addresses (Care Compare)

2748 San Pablo Ave
Berkeley, CA 94702-2240
Phone (510) 841-0681

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AU3952CAMDAudiologist
3952CAMDSpeech-Language Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Berkeley Hearing Center LLC Audiologist CurrentSince Aug 12, 2024 Accepting new patients

Locations

2748 San Pablo Ave
Berkeley, CA 94702
Phone (510) 841-0681

2478 San Pablo Ave
Berkeley, CA 94702
Phone (510) 841-0681

Organizations & group practices 1

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": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1164257697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2748 SAN PABLO AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022240",
            "telephone_number": "510-841-0681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2748 SAN PABLO AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022240",
            "telephone_number": "510-841-0681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBOIRON-COHEN",
        "first_name": "GABRIEL",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU3952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.