Active NPI
Carly Liberatore
- Physician Assistant
- Bala Cynwyd, PA
National Provider Identifier
1346013349
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- OA006729
- Practice address
- 9 Presidential Blvd Unit 103
Bala Cynwyd, PA 19004-1025 - Phone
- (610) 934-4100
- NPI assigned
- Nov 1, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | OA006729 | PA | Primary |
Addresses
Primary practice location
9 Presidential Blvd Unit 103
Bala Cynwyd, PA 19004-1025
Mailing address
1547 Wickerton Dr
West Chester, PA 19382-7755
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1632 Pine St
Philadelphia, PA 19103-6711
Phone (215) 670-5843
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/HIEGAA
Organizations & group practices 1
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.
-
- Primary Care Clinic/Center
- Philadelphia, PA
- NPI 1568631430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698796800000",
"number": "1346013349",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1547 WICKERTON DR",
"city": "WEST CHESTER",
"state": "PA",
"postal_code": "193827755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 PRESIDENTIAL BLVD UNIT 103",
"city": "BALA CYNWYD",
"state": "PA",
"postal_code": "190041025",
"telephone_number": "610-934-4100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBERATORE",
"first_name": "CARLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-11-01",
"last_updated": "2023-11-01",
"certification_date": "2023-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "OA006729",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bala Cynwyd, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.