Individual provider Active NPI

John Brian Liddy, M.D.

  • Anesthesiology Physician
  • Springfield, OR
National Provider Identifier
1568564912
Registry record updated Nov 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD154919 Issued in OR
Practice address
3333 Riverbend Dr
Springfield, OR 97477-8800
Phone
(541) 222-3154
Fax
(503) 225-9002
NPI assigned
Sep 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD154919 OR Primary

Addresses

Primary practice location

3333 Riverbend Dr
Springfield, OR 97477-8800

Mailing address

PO Box 7247
Springfield, OR 97475-0011
Phone (541) 686-9551

Other identifiers 1

IdentifierTypeStateIssuer
500637179MedicaidOR

Other names 1

  • Pax Anesthesia Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20110830000760 OR Practitioner - AnesthesiologyPractitioner - Pain Management 5092774992 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
University of Vermont College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest Anesthesia Physicians PCGroup PAC ID 3274420138, 93 clinicians

Practice addresses (Care Compare)

1460 G St
Springfield, OR 97477-4112
Phone (541) 726-4402

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Anesthesiology Group PC Anesthesiology CurrentSince May 3, 2020 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Jul 5, 2023 Accepting new patients
Northwest Anesthesia Physicians PC Anesthesiology CurrentSince Aug 1, 2020 Accepting new patients
Cep America - Anesthesia PC Anesthesiology CurrentSince Jul 5, 2023 Accepting new patients
Pacific Surgery Center LLC Anesthesiology CurrentSince Nov 29, 2022 Accepting new patients
Oag Trauma Services LLC Anesthesiology Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

633 Waverly Dr SE
Albany, OR 97322
Phone (541) 286-2309

74B Centennial Loop
Ste 100
Eugene, OR 97401
Phone (541) 686-3791

1125 Darlene Ln
Ste 201
Eugene, OR 97401
Phone (541) 342-1845

1410 Oak St
Ste 300
Eugene, OR 97401
Phone (541) 228-3662

1125 Darlene Ln
Eugene, OR 97401
Phone (541) 683-5488

1111 Crater Lake Ave
Medford, OR 97504
Phone (541) 732-5250

707 SW Washington St
Ste 700
Portland, OR 97205

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

1445 State St
Salem, OR 97301
Phone (503) 315-7338

1460 G St
Springfield, OR 97477
Phone (541) 431-0665

3333 Riverbend Dr
Springfield, OR 97477
Phone (541) 222-3154

2400 Hartman Ln
Ste 300
Springfield, OR 97477
Phone (541) 343-1603

Interoperability endpoints

  • Direct secure messaging: jliddy@yourcarecommunity.org

Organizations & group practices 6

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.

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": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1568564912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7247",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974750011",
            "telephone_number": "541-686-9551",
            "fax_number": "541-687-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 RIVERBEND DR",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974778800",
            "telephone_number": "541-222-3154",
            "fax_number": "503-225-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDY",
        "first_name": "JOHN",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-05",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD154919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500637179",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAX",
            "last_name": "ANESTHESIA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.