Liberty Eye Surgical Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

17401501 Issued in PA

Legal business name

LIBERTY EYE SURGICAL CENTER LLC

Practice address

9122 Blue Grass Rd
Philadelphia, PA 19114-3202

Phone

(215) 673-9231

Fax

(215) 673-9236

NPI assigned

May 2, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Dennis Slochower, M.D.

Title

Medical Director

Phone

(215) 673-9231

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

Liberty Eye Surgical Center LLCCCN 39C0001165

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Liberty Eye Surgery Ctr2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Liberty Eye Surgical Center

  • Ambulatory Surgical Clinic/Center
  • Philadelphia, PA
  • NPI 1649325713
  NPD tax ID

Locations

Practitioners 1

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

• Iftikhar M Chaudhry, MD

  • Ophthalmology Physician
  • Bensalem, PA
  • NPI 1700874740
  NPD (past)

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

{
    "created_epoch": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291852800000",
    "number": "1447218433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9122 BLUE GRASS RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191143202",
            "telephone_number": "215-673-9231",
            "fax_number": "215-673-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9122 BLUE GRASS RD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191143202",
            "telephone_number": "215-673-9231",
            "fax_number": "215-673-9236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY EYE SURGICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2010-12-09",
        "status": "A",
        "authorized_official_last_name": "SLOCHOWER",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "215-673-9231",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "17401501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTHCARE",
            "identifier": "3562638",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HMO",
            "identifier": "0001624000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0001624000",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35387",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100964206001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30019554",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Liberto
• Liberty Bell Home Care Services, Inc.
• Liberty Community Connections, Inc
• Liberty Dental, LLC
• Liberty Eye Surgical Center
• Liberty Home Care Services LLC
• Liberty in-Home Health Care LLC
• Liberty Medical Group PC
• Liberty Medical Response LLC.
• Liberty Pharmacy Inc

• Ambulatory Surgical Clinic/Center in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.