Individual provider Active NPI

Ian M Liebold, CRNP

  • Family Nurse Practitioner
  • Stroudsburg, PA
National Provider Identifier
1265198030
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP024724 Issued in PA
Practice address
600 Commerce Blvd
Stroudsburg, PA 18360-6214
Phone
(570) 424-7390
Fax
(570) 424-7395
NPI assigned
Nov 16, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP024724 PA Primary

Addresses

Primary practice location

600 Commerce Blvd
Stroudsburg, PA 18360-6214

Mailing address

2100 Mack Blvd FL 4
Allentown, PA 18103-5622
Phone (484) 629-2282

Other identifiers 1

IdentifierTypeStateIssuer
SP024724OtherPASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220322000480 PA Practitioner - Nurse Practitioner 8022403492 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

2100 Mack Blvd
FL 4
Allentown, PA 18103-5622

5649 Wynnewood Dr
Laurys Station, PA 18059-1124

600 Commerce Blvd
Stroudsburg, PA 18360-6214
Phone (570) 424-7390

Hospital & facility affiliations

  • Lehigh Valley Hospital - Pocono Hospital, East Stroudsburg, PA, CCN 390201
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133

Merit-based Incentive Payment System (MIPS)

Final score
81.09 of 100Reported as group
Quality
74.47
Promoting interoperability
86
Improvement activities
40
Cost
74.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP024724PAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group Current Accepting new patients
Family Care Centers Inc CurrentSince Jan 10, 2022 Accepting new patients
Lehigh Valley Physician Group CurrentSince Jan 1, 2025 Accepting new patients
Family Care Centers Inc. CurrentSince Jan 10, 2022 Accepting new patients
Lehigh Valley Physician Group CurrentSince Jan 1, 2025 Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

500 Plaza Ct
Ste A
East Stroudsburg, PA 18301
Phone (570) 424-9970

500 Plaza Ct
East Stroudsburg, PA 18301
Phone (570) 426-2330

179 Independence Rd
East Stroudsburg, PA 18301
Phone (570) 421-8526

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

600 Commerce Blvd
Fl 3
Stroudsburg, PA 18360
Phone (570) 426-6070

600 Commerce Blvd
Stroudsburg, PA 18360
Phone (570) 424-7390

Interoperability endpoints

  • Direct secure messaging: iliebold37748@direct2.lvhn.org

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 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": "1637020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1265198030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 MACK BLVD FL 4",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181035622",
            "telephone_number": "484-629-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 COMMERCE BLVD",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183606214",
            "telephone_number": "570-424-7390",
            "fax_number": "570-424-7395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBOLD",
        "first_name": "IAN",
        "middle_name": "M",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-16",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP024724",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "SP024724",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stroudsburg, PA

Sources for this page

Verify at the official NPI Registry.