Individual provider Active NPI

Sandy Lieberman, MD

  • Pediatrics Physician
  • Bay Harbor Islands, FL
National Provider Identifier
1457360109
Registry record updated Jun 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME69536 Issued in FL
Practice address
1145 Kane Concourse
Bay Harbor Islands, FL 33154-2012
Phone
(305) 865-5439
Fax
(305) 866-5366
NPI assigned
Aug 5, 2006
Last updated
Jun 17, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME69536 FL Primary

Addresses

Primary practice location

1145 Kane Concourse
Bay Harbor Islands, FL 33154-2012

Mailing address

1145 Kane Concourse
Bay Harbor Islands, FL 33154-2012
Phone (305) 865-5439

Other identifiers 1

IdentifierTypeStateIssuer
250028100MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME69536FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vitalmd Group Holding LLC Pediatrics Past Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22855/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560729600000",
    "number": "1457360109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 KANE CONCOURSE",
            "city": "BAY HARBOR ISLANDS",
            "state": "FL",
            "postal_code": "331542012",
            "telephone_number": "305-865-5439",
            "fax_number": "305-866-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 KANE CONCOURSE",
            "city": "BAY HARBOR ISLANDS",
            "state": "FL",
            "postal_code": "331542012",
            "telephone_number": "305-865-5439",
            "fax_number": "305-866-5366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "SANDY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2019-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME69536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250028100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bay Harbor Islands, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.