NPIMap

Individual provider Active NPI

Randy Alan Lieberman, MD

  • Clinical Cardiac Electrophysiology Physician
  • Detroit, MI
National Provider Identifier
1679513543
Registry record updated Feb 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
4301074561 Issued in MI
Practice address
4201 Saint Antoine St Ste 7B
Detroit, MI 48201-2153
Phone
(313) 745-0233
Fax
(313) 993-0295
NPI assigned
Jun 7, 2006
Last updated
Feb 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301074561 MI
Cardiovascular Disease Physician 207RC0000X 4301074561 MI
Clinical Cardiac Electrophysiology Physician 207RC0001X 4301074561 MI Primary

Addresses

Primary practice location

4201 Saint Antoine St Ste 7B
Detroit, MI 48201-2153

Mailing address

400 Mack Ave
Detroit, MI 48201-2136

Other practice location 1

400 Mack Ave
Detroit, MI 48201-2136
Phone (313) 448-9650

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20050829000617 MI Practitioner - Cardiac ElectrophysiologyPractitioner - Cardiovascular Disease (Cardiology) 8325095722 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac ElectrophysiologyAlso: Cardiovascular Disease (Cardiology)
Education
Wright State University Boonshoft School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4201 Saint Antoine St
Detroit, MI 48201-2153
Phone (313) 745-4525

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.38 of 100Reported as individual
Quality
61.02
Promoting interoperability
100
Improvement activities
40
Cost
90.24

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair39

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301074561MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Physician Group Internal Medicine CurrentSince Sep 13, 2017 Accepting new patients
Harper Hutzel Hospital Past Accepting new patients
VHS Harper-Hutzel Hospital Inc Past Accepting new patients
Heart Care PC Cardiovascular Disease PastSince Aug 28, 2021 Accepting new patients
University Physician Group Past Accepting new patients
N Gupta MD PC Cardiovascular Disease Past Accepting new patients

Locations

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

3901 Beaubien St
Detroit, MI 48201
Phone (313) 745-5227

3990 John R St
Detroit, MI 48201
Phone (313) 745-6211

3990 John R St
Ofc
Detroit, MI 48201

400 Mack Ave
Detroit, MI 48201
Phone (313) 448-9006

4100 John R St
Detroit, MI 48201
Phone (313) 576-8530

4201 Saint Antoine St
#5A
Detroit, MI 48201

4201 Saint Antoine St
#5B
Detroit, MI 48201

4201 Saint Antoine St
Ste 5A
Detroit, MI 48201
Phone (313) 966-2492

4201 Saint Antoine St
Ste 7B
Detroit, MI 48201
Phone (313) 745-0233

1560 E Maple Rd
Ste 200
Troy, MI 48083
Phone (248) 581-5200

1560 E Maple Rd
Ste 400
Troy, MI 48083

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20439/brand/1/csg/1/fhir/r4
  • Direct secure messaging: randy.lieberman.1@19711.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645747200000",
    "number": "1679513543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MACK AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 SAINT ANTOINE ST STE 7B",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012153",
            "telephone_number": "313-745-0233",
            "fax_number": "313-993-0295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Mack Ave",
            "address_purpose": "LOCATION",
            "city": "Detroit",
            "state": "MI",
            "postal_code": "482012136",
            "country_code": "US",
            "telephone_number": "313-448-9650",
            "fax_number": "313-448-9979",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "RANDY",
        "middle_name": "ALAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301074561",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "4301074561",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "MI",
            "license": "4301074561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.