Jeffery Joseph Libra, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301048963 Issued in MI

Practice address

3355 Eagle Park Dr NE Ste 103
Grand Rapids, MI 49525

Phone

(616) 942-7400

Fax

(616) 942-7405

NPI assigned

Mar 12, 2007

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Careline Hmi300 LLC

  • Community Based Hospice Care Agency
  • Grand Rapids, MI
  • NPI 1770257818

  Family Medicine

  NPD (past)
• Grand Valley Family Health Center

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1306062237
  NPD (past)
• Iah of Michigan, PLLC

  • Family Medicine Physician
  • Troy, MI
  • NPI 1578969705
  NPD (past)

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560816000000",
    "number": "1619009826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3355 EAGLE PARK DR NE STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257004",
            "telephone_number": "616-942-7400",
            "fax_number": "616-942-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3355 EAGLE PARK DR NE STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-942-7400",
            "fax_number": "616-942-7405"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "451 Health Pkwy",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Paw Paw",
            "state": "MI",
            "postal_code": "490798242",
            "country_code": "US",
            "telephone_number": "269-657-2550",
            "fax_number": "269-657-2285",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "451 Health Pkwy",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Paw Paw",
            "state": "MI",
            "postal_code": "490798242",
            "country_code": "US",
            "telephone_number": "269-657-2550",
            "fax_number": "269-657-2285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIBRA",
        "first_name": "JEFFERY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2019-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301048963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619009826",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM - BRONSON LAKEVIEW",
            "identifier": "1235131137",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2843350",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zhe Liang, MD
• Theodore William Liao, M.D.
• Tressa K Liba, LLMSW, CCHW
• Earlina Libbett, MM
• Kydaeyania J Libbett
• Karissa Libson
• Kayla R Licari, P.A.-C
• Seraphino Licastro
• Kimberly Sue Lichon-Tufer, LMSW
• Melissa Lichtenwalter, RN

• Family Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.