NPIMap

Organization Active NPI

Liberty Orthopedics PS

Doing business as Liberty Knee Center

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Poulsbo, WA
National Provider Identifier
1639771348
Registry record updated Jan 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
LIBERTY ORTHOPEDICS PS
Doing business as
Liberty Knee Center
Practice address
20696 Bond Rd NE Ste 205
Poulsbo, WA 98370-9025
Phone
(360) 930-0222
Fax
(360) 210-1429
NPI assigned
Nov 9, 2020
Last updated
Jan 19, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2021

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

Authorized official

Name
John Reid West, MDNPI 1043473598
Title
President/Provider
Phone
(360) 801-7966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

20696 Bond Rd NE Ste 205
Poulsbo, WA 98370-9025

Mailing address

20696 Bond Rd NE Ste 205
Poulsbo, WA 98370-9025
Phone (360) 930-0222

Other identifiers 1

IdentifierTypeStateIssuer
2169137MedicaidWA

Other names 1

  • Liberty Knee Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201203000631 WA Part B Supplier - Clinic/Group Practice 9830500404 Receives reassigned benefits from 4 practitioners
Practice locations: Poulsbo, WA; Silverdale, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1604880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1639771348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20696 BOND RD NE STE 205",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983709025",
            "telephone_number": "360-930-0222",
            "fax_number": "360-210-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20696 BOND RD NE STE 205",
            "city": "POULSBO",
            "state": "WA",
            "postal_code": "983709025",
            "telephone_number": "360-930-0222",
            "fax_number": "360-210-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY ORTHOPEDICS PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-09",
        "last_updated": "2021-01-19",
        "certification_date": "2020-12-27",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "REID",
        "authorized_official_title_or_position": "PRESIDENT/PROVIDER",
        "authorized_official_telephone_number": "360-801-7966",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2169137",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Knee Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poulsbo, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.