NPIMap

Individual provider Active NPI

Mitchell Brent Liester, M.D.

  • Psychiatry Physician
  • Monument, CO
National Provider Identifier
1366430605
Registry record updated Jan 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
29395 Issued in CO
Practice address
153 Washington St
Suite 103
Monument, CO 80132-9181
Phone
(719) 488-0024
Fax
(719) 488-6672
NPI assigned
Oct 11, 2005
Last updated
Jan 8, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 29395 CO Primary

Addresses

Primary practice location

153 Washington St
Suite 103
Monument, CO 80132-9181

Mailing address

PO Box 302
Monument, CO 80132-0302
Phone (719) 488-0024

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20071112000528 CO Practitioner - Psychiatry 2264520055 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Colorado School of Medicine, Denver, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

153 N Washington St
Suite 103
Monument, CO 80132-9181
Phone (719) 488-0024

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29395COMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mitchell B. Liester, M.D., P.C. CurrentSince Jun 15, 2007 Accepting new patients

Locations

153 Washington St
Monument, CO 80132
Phone (719) 488-0402

153 Washington St
Unit 103
Monument, CO 80132
Phone (719) 488-0024

Interoperability endpoints

  • Direct secure messaging: mitchell.liester.1@17631.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357603200000",
    "number": "1366430605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 302",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801320302",
            "telephone_number": "719-488-0024",
            "fax_number": "719-488-6672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 WASHINGTON ST",
            "address_2": "SUITE 103",
            "city": "MONUMENT",
            "state": "CO",
            "postal_code": "801329181",
            "telephone_number": "719-488-0024",
            "fax_number": "719-488-6672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIESTER",
        "first_name": "MITCHELL",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2013-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CO",
            "license": "29395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monument, CO

Sources for this page

Verify at the official NPI Registry.