NPIMap

Organization Active NPI

Nysarc Inc Montgomery County Chapter Liberty

Doing business as Liberty Enterprises

  • Multi-Specialty Clinic/Center
  • Amsterdam, NY
National Provider Identifier
1376902734
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY
Doing business as
Liberty Enterprises
Practice address
47 Liberty Dr
Amsterdam, NY 12010
Phone
(518) 954-2027
Fax
(518) 954-2009
NPI assigned
Feb 15, 2016
Organization subpart
Yes
Parent organization
NYSARC INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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

Authorized official

Name
Ms. Jennifer Saunders
Title
Ceo
Phone
(518) 954-3223

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

47 Liberty Dr
Amsterdam, NY 12010

Mailing address

43 Liberty Dr
Amsterdam, NY 12010-5635
Phone (518) 954-3346

Other identifiers 18

IdentifierTypeStateIssuer
00644606MedicaidNY
02621043MedicaidNY
02247652MedicaidNY
02700049MedicaidNY
03588281MedicaidNY
01494471MedicaidNY
02171800MedicaidNY
02247698MedicaidNY
02416264MedicaidNY
02245476MedicaidNY
02714189MedicaidNY
02599411MedicaidNY
02061801MedicaidNY
02617792MedicaidNY
01385217MedicaidNY
01750518MedicaidNY
02002115MedicaidNY
02924252MedicaidNY

Other names 1

  • Liberty Enterprises Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160606000216 NY Part B Supplier - Clinic/Group Practice 1557651411 Receives reassigned benefits from 15 practitioners
Practice locations: Amsterdam, NY; Canajoharie, NY; Fort Plain, NY

National Provider Directory

National Provider Directory
Tax ID family
Liberty5 organizations share this tax ID, including this one
Part of
Putnam County Chapter Nys

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

91 W Main St
Canajoharie, NY 13317
Phone (518) 842-5080

66 Church St
Canajoharie, NY 13317
Phone (518) 842-5080

7 Main St
Fort Plain, NY 13339
Phone (518) 842-5080

204 Canal St
Fort Plain, NY 13339
Phone (518) 842-5080

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465257600000",
    "number": "1376902734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 LIBERTY DR",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "120105635",
            "telephone_number": "518-954-3346",
            "fax_number": "518-954-3308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 LIBERTY DR",
            "city": "AMSTERDAM",
            "state": "NY",
            "postal_code": "12010",
            "telephone_number": "518-954-2027",
            "fax_number": "518-954-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NYSARC INC MONTGOMERY COUNTY CHAPTER LIBERTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NYSARC INC",
        "enumeration_date": "2016-02-15",
        "last_updated": "2016-06-07",
        "status": "A",
        "authorized_official_last_name": "SAUNDERS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "518-954-3223",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00644606",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02621043",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02247652",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02700049",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03588281",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01494471",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02171800",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02247698",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02416264",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02245476",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02714189",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02599411",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02061801",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02617792",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01385217",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01750518",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02002115",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02924252",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Enterprises",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amsterdam, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.