Individual provider Active NPI

Charles Edmond Libby, MD

  • Urology Physician
  • Bronx, NY
National Provider Identifier
1306954946
Registry record updated Aug 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
150970 Issued in NY
Practice address
2015 Grand Concourse
Bronx, NY 10453-4303
Phone
(718) 299-7295
Fax
(718) 299-6797
NPI assigned
Aug 25, 2006
Last updated
Aug 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 150970 NY Primary

Addresses

Primary practice location

2015 Grand Concourse
Bronx, NY 10453-4303

Mailing address

1434 Williamsbridge Rd FL 2
Bronx, NY 10461-2507
Phone (718) 618-0401

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050310000137 NY Practitioner - Urology 5597719740 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
JS Weill Medical College, Cornell University, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shakespeare Operating LLCGroup PAC ID 0840604310, 144 clinicians

Practice addresses (Care Compare)

1250 Shakespeare Ave
Bronx, NY 10452-3012
Phone (646) 350-1633

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
TJH Medical Services, P.C. Urology CurrentSince Feb 1, 2015 Accepting new patients
Bronx Medical Practice P.C. CurrentSince Jul 30, 2021 Accepting new patients
Essen Medical Associates, PC CurrentSince Jul 30, 2021 Accepting new patients
Jamaica Hospital CurrentSince Feb 1, 2015 Accepting new patients
Shakespeare Operating LLC CurrentSince Feb 18, 2024 Accepting new patients
Essen Medical Associates, PC CurrentSince Jul 30, 2021 Accepting new patients
Jamaica Hospital CurrentSince Feb 1, 2015 Accepting new patients
House Call Medical Services of New York, PLLC CurrentSince Jul 30, 2021 Accepting new patients
Integrated Medical Professionals PLLC Urology PastSince Mar 1, 2024 Accepting new patients
Resource Anesthesiology Associates,PC Past Accepting new patients

Locations

1250 Shakespeare Ave
Bronx, NY 10452
Phone (646) 350-1633

1371 Seabury Ave
Bronx, NY 10461
Phone (718) 294-6200

1434 Williamsbridge Rd
Fl 2
Bronx, NY 10461
Phone (201) 641-2125

2015 Grand Concourse
Bronx, NY 10453
Phone (718) 294-6200

2505 Grand Ave
Bronx, NY 10468
Phone (718) 295-1400

8989 Union Tpke
Ste A
Glendale, NY 11385
Phone (718) 746-0400

11940 Metropolitan Ave
Kew Gardens, NY 11415
Phone (718) 849-0839

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

8900 Van Wyck Expy
Richmond Hill, NY 11418
Phone (718) 206-6088

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: charles.libby@ema.eclinicaldirectplus.com
  • Direct secure messaging: charleslibby@imppllc.allscriptsdirect.net

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1306954946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1434 WILLIAMSBRIDGE RD FL 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612507",
            "telephone_number": "718-618-0401",
            "fax_number": "347-479-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534303",
            "telephone_number": "718-299-7295",
            "fax_number": "718-299-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBBY",
        "first_name": "CHARLES",
        "middle_name": "EDMOND",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "150970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.