NPIMap

Individual provider Active NPI

Libby Fleischer Wilson, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Los Angeles, CA
National Provider Identifier
1568405546
Registry record updated Jan 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
G18778 Issued in CA
Practice address
403 W. Adams Blvd.
Los Angeles, CA 90007-2664
Phone
(213) 742-1433
Fax
(213) 742-1496
NPI assigned
Jun 14, 2006
Last updated
Jan 14, 2015By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 14, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G18778 CA
Plastic Surgery Physician 208200000X G18778 CA
Plastic and Reconstructive Surgery Physician 2086S0122X G18778 CA Primary

Addresses

Primary practice location

403 W. Adams Blvd.
Los Angeles, CA 90007-2664

Mailing address

403 W. Adams Blvd.
Los Angeles, CA 90007-2664
Phone (213) 742-1433

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060731000466 CA Practitioner - Plastic and Reconstructive Surgery 6406869817 Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Medical College of Pennsylvania, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

403 W Adams Blvd
Los Angeles, CA 90007-2664
Phone (213) 742-1433

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18778CAMDMental Health Counselor
G18778CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Dignity Community Care Past Accepting new patients
White Memorial Medical Center Past Accepting new patients
Keagle Medical, Inc. Plastic and Reconstructive Surgery Past Accepting new patients
The Regents of the University of California Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: libbywilson@cleft.ssdirect.aprima.com
  • Direct secure messaging: lwilson53510@direct.uclahealth.org

Organizations & group practices 7

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421193600000",
    "number": "1568405546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 W. ADAMS BLVD.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900072664",
            "telephone_number": "213-742-1433",
            "fax_number": "213-742-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 W. ADAMS BLVD.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900072664",
            "telephone_number": "213-742-1433",
            "fax_number": "213-742-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LIBBY",
        "middle_name": "FLEISCHER",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2015-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G18778",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "G18778",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "G18778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.