Active NPI
R Scott Liebl, MD
- Surgery Physician
- Oconto Falls, WI
National Provider Identifier
1639166853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 21763020
- Practice address
- 835 S Main St
Suite 1
Oconto Falls, WI 54154-1241 - Phone
- (920) 846-8424
- Fax
- (920) 846-2073
- NPI assigned
- Oct 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 21763020 | WI | Primary |
Addresses
Primary practice location
835 S Main St
Suite 1
Oconto Falls, WI 54154-1241
Mailing address
835 S Main St
Suite 1
Oconto Falls, WI 54154-1241
Phone (920) 846-8424
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11014110 | Medicaid | WI | |
| 1851477913 | Other | NPI | |
| 390848401050 | Other | WI | BXBS |
| 30189000 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21763020 | WI | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Clare Memorial Hospital, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Oconto Falls, WI
- NPI 1851477913
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409616000000",
"number": "1639166853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "835 S MAIN ST",
"address_2": "SUITE 1",
"city": "OCONTO FALLS",
"state": "WI",
"postal_code": "541541241",
"telephone_number": "920-846-8424",
"fax_number": "920-846-2073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "835 S MAIN ST",
"address_2": "SUITE 1",
"city": "OCONTO FALLS",
"state": "WI",
"postal_code": "541541241",
"telephone_number": "920-846-8424",
"fax_number": "920-846-2073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBL",
"first_name": "R",
"middle_name": "SCOTT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-03",
"last_updated": "2014-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WI",
"license": "21763020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "11014110",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1851477913",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BXBS",
"identifier": "390848401050",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30189000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oconto Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.