NPIMap

Individual provider Active NPI

Mary-Liberty Y Gibbs, D.O.

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1235425448
Registry record updated Feb 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO2536 Issued in NV
Practice address
6210 N Durango Dr BLDG 11
Las Vegas, NV 89149-3916
Phone
(702) 940-1540
Fax
(702) 940-1541
NPI assigned
Jun 26, 2011
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0102203392 VA
Family Medicine Physician 207Q00000X DO2536 NV Primary

Addresses

Primary practice location

6210 N Durango Dr BLDG 11
Las Vegas, NV 89149-3916

Mailing address

10624 S Eastern Ave
# A-955
Henderson, NV 89052-2982
Phone (702) 407-7700

Other identifiers 2

IdentifierTypeStateIssuer
DO2536OtherNVSTATE LICENSE
1235425448MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20190626000413 NV Practitioner - Internal Medicine 1456626902 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
West Virginia School of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Platinum Hospitalists LLPGroup PAC ID 7214076322, 197 clinicians

Practice addresses (Care Compare)

7495 W Azure Dr
Suite 209
Las Vegas, NV 89130-4440
Phone (702) 407-7700

Hospital & facility affiliations

  • Compassioncare Hospice Hospice, Las Vegas, NV, CCN 291516
  • Summerlin Hospital Medical Center Hospital, Las Vegas, NV, CCN 290041

Merit-based Incentive Payment System (MIPS)

Final score
61.15 of 100Reported as group
Quality
36.67
Improvement activities
40
Cost
61.8

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO2536NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Platinum Hospitalists LLP Family Medicine CurrentSince Mar 1, 2021 Accepting new patients
Healthcare Partners Medical Group Coats LTD Family Medicine Current Accepting new patients
Platinum Hospitalists LLP Family Medicine CurrentSince Mar 1, 2021 Accepting new patients
Talbert Medical Group PastSince Jun 10, 2019 Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Intermountain Medical Holdings Nevada Inc Family Medicine Past Accepting new patients

Locations

10624 S Eastern Ave
Ste A995
Henderson, NV 89052

10624 S Eastern Ave
#A955
Henderson, NV 89052
Phone (702) 407-7700

7495 W Azure Dr
Ste 209
Las Vegas, NV 89130
Phone (702) 327-6653

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1309046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1235425448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10624 S EASTERN AVE",
            "address_2": "# A-955",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522982",
            "telephone_number": "702-407-7700",
            "fax_number": "702-407-7016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6210 N DURANGO DR BLDG 11",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891493916",
            "telephone_number": "702-940-1540",
            "fax_number": "702-940-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBBS",
        "first_name": "MARY-LIBERTY",
        "middle_name": "Y",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-26",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0102203392",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "DO2536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "DO2536",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235425448",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.