Individual provider Active NPI

James L. Livermore, MD

  • Pediatrics Physician
  • Dubuque, IA
National Provider Identifier
1497846679
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
38859 Issued in IA
Practice address
1789 Elm St
Suite a
Dubuque, IA 52001-2256
Phone
(563) 690-2860
Fax
(563) 582-5335
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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 38859 IA Primary

Addresses

Primary practice location

1789 Elm St
Suite a
Dubuque, IA 52001-2256

Mailing address

1789 Elm St
Suite a
Dubuque, IA 52001-2256
Phone (563) 690-2860

Other identifiers 1

IdentifierTypeStateIssuer
200522050MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150211000806 IA Practitioner - Pediatric Medicine 1052636289 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
38859IAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Crescent Community Health Center CurrentSince Nov 7, 2023 Accepting new patients

Locations

1789 Elm St
Ste A
Dubuque, IA 52001
Phone (563) 690-2850

1690 Elm St
Ste 300
Dubuque, IA 52001
Phone (563) 690-2850

Interoperability endpoints

  • Direct secure messaging: jlivermore637339@direct.ochin.org

Organizations & group practices 1

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": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1497846679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1789 ELM ST",
            "address_2": "SUITE A",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520012256",
            "telephone_number": "563-690-2860",
            "fax_number": "563-582-5335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1789 ELM ST",
            "address_2": "SUITE A",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520012256",
            "telephone_number": "563-690-2860",
            "fax_number": "563-582-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIVERMORE",
        "first_name": "JAMES",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IA",
            "license": "38859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200522050",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dubuque, IA

Sources for this page

Verify at the official NPI Registry.