NPIMap

Organization Active NPI

Children's Medical Group, Inc., D/B/a Liberty Pediatrics

  • Pediatrics Physician
  • Newport News, VA
National Provider Identifier
1386652824
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CHILDREN'S MEDICAL GROUP, INC., D/B/A LIBERTY PEDIATRICS
Practice address
12705 McManus Blvd
Newport News, VA 23602-4459
Phone
(757) 668-4800
Fax
(757) 668-4828
NPI assigned
Aug 3, 2006
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Kathryn J Abshire
Title
Senior VP/Cfo
Phone
(757) 668-8565

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

12705 McManus Blvd
Newport News, VA 23602-4459

Mailing address

606 Denbigh Blvd
Suite 400
Newport News, VA 23608-4413
Phone (757) 833-0780

Other identifiers 1

IdentifierTypeStateIssuer
174005OtherVAANTHEM

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1037077Children's Medical Group, Inc12705 McManus Boulevard, Newport News, VA 23602Certificate of waiverSep 7, 2026

National Provider Directory

National Provider Directory
Tax ID family
Children's Medical Group Inc Dba Liberty Pediatrics16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

12705 McManus Blvd
Newport News, VA 23602
Phone (757) 668-4800

606 Denbigh Blvd
Ste 400
Newport News, VA 23608
Phone (757) 833-0780

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1386652824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "606 DENBIGH BLVD",
            "address_2": "SUITE 400",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236084413",
            "telephone_number": "757-833-0780",
            "fax_number": "757-833-0783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12705 MCMANUS BLVD",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024459",
            "telephone_number": "757-668-4800",
            "fax_number": "757-668-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S MEDICAL GROUP, INC., D/B/A LIBERTY PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "ABSHIRE",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SENIOR VP/CFO",
        "authorized_official_telephone_number": "757-668-8565"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "174005",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.