Active NPI
Hailey Beth Libengood, PA-C
- Physician Assistant
- Charleston, SC
National Provider Identifier
1508224015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2445
- Practice address
- 135 Rutledge Ave
Charleston, SC 29425-8903 - Phone
- (843) 792-3328
- NPI assigned
- Jan 29, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2445 | SC | Primary |
Addresses
Primary practice location
135 Rutledge Ave
Charleston, SC 29425-8903
Mailing address
PO Box 1245
Orangeburg, SC 29116-1245
Phone (803) 395-4497
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160629002704 | SC | Practitioner - Physician Assistant | 0840582441 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2445 | SC | MD | Physical Therapist |
Interoperability endpoints
- hailey.libengood.1@15910.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1454025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470355200000",
"number": "1508224015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1245",
"city": "ORANGEBURG",
"state": "SC",
"postal_code": "291161245",
"telephone_number": "803-395-4497",
"fax_number": "803-395-2237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 RUTLEDGE AVE",
"city": "CHARLESTON",
"state": "SC",
"postal_code": "294258903",
"telephone_number": "843-792-3328"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIBENGOOD",
"first_name": "HAILEY",
"middle_name": "BETH",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-01-29",
"last_updated": "2016-08-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "SC",
"license": "2445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.