NPIMap

Organization Active NPI

Liberty Medicine Specialists, Inc.

  • Endocrinology, Diabetes & Metabolism Physician
  • Liberty, MO
National Provider Identifier
1194762930
Registry record updated Apr 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
R4935 Issued in MO
Legal business name
LIBERTY MEDICINE SPECIALISTS, INC.
Practice address
550 Rush Creek Pkwy
Ste B
Liberty, MO 64068-9604
Phone
(816) 781-8100
Fax
(816) 781-3374
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2009

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

Authorized official

Name
Donna G Welch
Title
Manager
Phone
(816) 781-8100

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X R6J63 MO
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 110760 MO
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X R8A47 MO
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X R4935 MO Primary
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X 109247 MO

Addresses

Primary practice location

550 Rush Creek Pkwy
Ste B
Liberty, MO 64068-9604

Mailing address

550 Rush Creek Pkwy
Ste B
Liberty, MO 64068-9604
Phone (816) 781-8100

Other identifiers 2

IdentifierTypeStateIssuer
502511207MedicaidMO
06797011OtherMOBCBS GROUP NUMBER

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239580800000",
    "number": "1194762930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 RUSH CREEK PKWY",
            "address_2": "STE B",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689604",
            "telephone_number": "816-781-8100",
            "fax_number": "816-781-3374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 RUSH CREEK PKWY",
            "address_2": "STE B",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689604",
            "telephone_number": "816-781-8100",
            "fax_number": "816-781-3374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICINE SPECIALISTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2009-04-13",
        "status": "A",
        "authorized_official_last_name": "WELCH",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "816-781-8100"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R6J63",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "110760",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "R8A47",
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "R4935",
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MO",
            "license": "109247",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "502511207",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "06797011",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.