NPIMap

Organization Active NPI

Liberty Medical Development, LLC

  • Ambulatory Surgical Clinic/Center
  • Christiansted, VI
National Provider Identifier
1528623329
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
LIBERTY MEDICAL DEVELOPMENT, LLC
Practice address
4006 Estate Diamond Ste 203
Christiansted, VI 00820-4534
Phone
(340) 718-2664
Fax
(340) 779-2443
NPI assigned
May 7, 2019
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Mr. Brian Bacot, MDNPI 1356333843
Title
Ceo
Phone
(340) 779-2663

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

4006 Estate Diamond Ste 203
Christiansted, VI 00820-4534

Mailing address

PO Box 11567
St Thomas, VI 00801-4567
Phone (340) 779-2663

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200508000854 VI Part B Supplier - Ambulatory Surgical Center 3375974249 Practice locations: Christiansted, VI

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Liberty Medical Development Dba St Croix Surgical CenterCCN 48C0001001
Medicare certification status
ActiveFrom the Provider of Services file

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
48D2171475Liberty Medical Development4006 Estate Diamond, Christiansted, VI 00820Certificate of waiverSep 2, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4006 Estate Diamond
Ste 201
St Croix, VI 00820
Phone (340) 718-2665

4006 Estate Diamond
Ste 203
St Croix, VI 00820
Phone (340) 718-2664

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1557187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1528623329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11567",
            "city": "ST THOMAS",
            "state": "VI",
            "postal_code": "008014567",
            "telephone_number": "340-779-2663",
            "fax_number": "340-779-2443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4006 ESTATE DIAMOND STE 203",
            "city": "CHRISTIANSTED",
            "state": "VI",
            "postal_code": "008204534",
            "telephone_number": "340-718-2664",
            "fax_number": "340-779-2443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY MEDICAL DEVELOPMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-07",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "BACOT",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "340-779-2663",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Christiansted, VI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; 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.