NPIMap

Individual provider Active NPI

Brent Binkley Liebert, M.D.

  • Family Medicine Physician
  • Johnston, IA
National Provider Identifier
1720078421
Registry record updated Aug 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25797 Issued in IA
Practice address
5731 Greendale Rd
Suite 100
Johnston, IA 50131-1593
Phone
(515) 270-1000
Fax
(515) 331-6581
NPI assigned
Oct 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25797 IA Primary
Emergency Medicine Physician 207P00000X 25797 IA

Addresses

Primary practice location

5731 Greendale Rd
Suite 100
Johnston, IA 50131-1593

Mailing address

5731 Greendale Rd
Suite 100
Johnston, IA 50131-1593
Phone (515) 270-1000

Other identifiers 2

IdentifierTypeStateIssuer
1720078421OtherIABLUE SHIELD
1720078421MedicaidIA

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

LicenseStateTypeSpecialty
25797IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Doctorsnow Doral LLC Past Accepting new patients
Covenant Medical Center Inc Family Medicine Past Accepting new patients
Covenant Medical Center, Inc. Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250640000000",
    "number": "1720078421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5731 GREENDALE RD",
            "address_2": "SUITE 100",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311593",
            "telephone_number": "515-270-1000",
            "fax_number": "515-331-6581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5731 GREENDALE RD",
            "address_2": "SUITE 100",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311593",
            "telephone_number": "515-270-1000",
            "fax_number": "515-331-6581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERT",
        "first_name": "BRENT",
        "middle_name": "BINKLEY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2009-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "25797",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IA",
            "license": "25797",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "1720078421",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720078421",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnston, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2009; 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.