NPIMap

Individual provider Active NPI

Matthew John Liepke, M.D.

  • Internal Medicine Physician
  • Oswego, NY
National Provider Identifier
1245220656
Registry record updated Mar 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
234523 Issued in NY
Practice address
33 E Schuyler St
Oswego, NY 13126-1161
Phone
(315) 343-6974
Fax
(315) 342-3625
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2011

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 234523 NY Primary
Pediatrics Physician 208000000X 234523 NY

Addresses

Primary practice location

33 E Schuyler St
Oswego, NY 13126-1161

Mailing address

33 E Schuyler St
Oswego, NY 13126-1161
Phone (315) 343-6974

Other identifiers 1

IdentifierTypeStateIssuer
02635330MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20050405001054 NY Practitioner - Internal MedicinePractitioner - Pediatric Medicine 9739136466 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
State University of Ny Upstate Medical University, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Port City Family Medicine PC IncGroup PAC ID 2567350606, 4 clinicians

Practice addresses (Care Compare)

33 E Schuyler St
Oswego, NY 13126-1161
Phone (315) 343-6974

Hospital & facility affiliations

  • Oswego Health Home Care, LLC Home health agency, Fulton, NY, CCN 337284
  • Centerwell Home Health Home health agency, Liverpool, NY, CCN 337255
  • Hospice of Central New York Hospice, Liverpool, NY, CCN 331511
  • Oswego Hospital Hospital, Oswego, NY, CCN 330218
  • River Hospital Clinics Hospital, Alexandria Bay, NY, CCN 331309

Merit-based Incentive Payment System (MIPS)

Final score
60.15 of 100Reported as group
Quality
75.12
Promoting interoperability
0
Improvement activities
40
Cost
75.37

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Port City Family Medicine P.C. Inc Internal Medicine CurrentSince May 1, 2005 Accepting new patients
Miami Valley Emergency Specialists, LLC Past Accepting new patients

Locations

33 E Schuyler St
Oswego, NY 13126
Phone (315) 343-6974

Interoperability endpoints

  • Direct secure messaging: mliepke@portcityfamily.medentdirect.com

Organizations & group practices 2

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 6

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": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301011200000",
    "number": "1245220656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 E SCHUYLER ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131261161",
            "telephone_number": "315-343-6974",
            "fax_number": "315-342-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 E SCHUYLER ST",
            "city": "OSWEGO",
            "state": "NY",
            "postal_code": "131261161",
            "telephone_number": "315-343-6974",
            "fax_number": "315-342-3625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEPKE",
        "first_name": "MATTHEW",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2011-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "234523",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "234523",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02635330",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oswego, NY

Sources for this page

Verify at the official NPI Registry.