Jonathan Libby, DNP, APRN, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

041889 Issued in ME

Practice address

100 Campus Ave Apt 203
Lewiston, ME 04240-6079

Phone

(207) 755-3160

Fax

(207) 755-3166

NPI assigned

Apr 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Specialty

Nurse Practitioner

Education

Other, 1975

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jlibby1153130@direct.bsmhealth.org

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.

• Community Clinical Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Lewiston, ME
  • NPI 1164477568
  NPD (past)
• St. Mary'S Regional Medical Center

  • General Acute Care Hospital
  • Lewiston, ME
  • NPI 1447226584
  NPD (past)

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433289600000",
    "number": "1558324772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10187",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122015187",
            "telephone_number": "207-777-4111",
            "fax_number": "207-783-6660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CAMPUS AVE APT 203",
            "city": "LEWISTON",
            "state": "ME",
            "postal_code": "042406079",
            "telephone_number": "207-755-3160",
            "fax_number": "207-755-3166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBBY",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "DNP, APRN, CPNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2015-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ME",
            "license": "041889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "245420099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lewiston School Department
• Lewiston-Auburn Pathology
• Bryce JF Libby, LCSW
• John Libby, LCSW
• John K Libby, PT
• Michael Eric Libby
• Anita Lichman, LCSW
• Life Ideals, LLC
• Life Seasons, LLC
• Life, Elevated LLC

• Pediatric Nurse Practitioner in Lewiston, ME
• Providers in Lewiston, ME by specialty
• Pediatric Nurse Practitioner in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; 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.
• 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.