Individual provider Active NPI

Kevin Michael Liebe, AUD

  • Audiologist
  • Kennewick, WA
National Provider Identifier
1376791186
Registry record updated Mar 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
LD60098277 Issued in WA
Practice address
924 N Columbia Center Blvd Ste 210
Kennewick, WA 99336
Phone
(509) 572-2444
Fax
(509) 572-2124
NPI assigned
Sep 4, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X LD60098277 WA
Audiologist 231H00000X LD60098277 WA Primary

Addresses

Primary practice location

924 N Columbia Center Blvd Ste 210
Kennewick, WA 99336

Mailing address

924 N Columbia Center Blvd Ste 210
Kennewick, WA 99336-7626
Phone (509) 572-2444

Other identifiers 1

IdentifierTypeStateIssuer
2105616MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180926002942 WA Practitioner - Qualified Audiologist 0749531978 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Audiology and Hearing AIDS, LLCGroup PAC ID 9032498548, 6 clinicians

Practice addresses (Care Compare)

457 SW 148TH St
Suite 101
Burien, WA 98166-1975
Phone (206) 246-8677

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LD60098277WAMDAudiologist-Hearing Aid Fitter

Practice roles

OrganizationSpecialtyStatusNew patients
Prosser Public Hospital District of Benton County Current Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince Apr 11, 2019 Accepting new patients
Prosser Public Hospital District of Benton County CurrentSince Apr 11, 2019 Accepting new patients
Highline Audiology PC Audiologist PastSince Sep 24, 2018 Accepting new patients

Locations

1105 Dale Ave
Benton City, WA 99320
Phone (509) 588-4075

200 Prosser Health Dr
Prosser, WA 99350
Phone (509) 786-2222

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553472000000",
    "number": "1376791186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "924 N COLUMBIA CENTER BLVD STE 210",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993367626",
            "telephone_number": "509-572-2444",
            "fax_number": "509-572-2124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 N COLUMBIA CENTER BLVD STE 210",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "99336",
            "telephone_number": "509-572-2444",
            "fax_number": "509-572-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBE",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-04",
        "last_updated": "2019-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "WA",
            "license": "LD60098277",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WA",
            "license": "LD60098277",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2105616",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.