NPIMap

Individual provider Active NPI

Vanson Reyes Libre, M.D.

  • Family Medicine Physician
  • Gig Harbor, WA
National Provider Identifier
1750720165
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD60596361 Issued in WA
Practice address
11511 Canterwood Blvd Ste 320
Gig Harbor, WA 98332-5813
Phone
(253) 857-1350
Fax
(253) 857-1399
NPI assigned
Jun 19, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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 LL36009 SC
Family Medicine Physician 207Q00000X MD60596361 WA Primary

Addresses

Primary practice location

11511 Canterwood Blvd Ste 320
Gig Harbor, WA 98332-5813

Mailing address

11511 Canterwood Blvd Ste 320
Gig Harbor, WA 98332-5813
Phone (253) 857-1350

Other identifiers 1

IdentifierTypeStateIssuer
2067092MedicaidWA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vlibre197748@fhsce.catholichealth.net Direct Franciscan Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20161017002372 WA Practitioner - Family Practice 2769616135 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Franciscan Medical GroupGroup PAC ID 0547173866, 1,400 clinicians

Practice addresses (Care Compare)

11511 Canterwood Blvd
Gig Harbor, WA 98332-5813

11511 Canterwood Blvd NW
Suite 100
Gig Harbor, WA 98332-5813
Phone (253) 627-1244

1812 S J St
Suite 120
Tacoma, WA 98405-4965
Phone (253) 428-2200

6401 Kimball Dr
Gig Harbor, WA 98335-1228

Hospital & facility affiliations

  • Assured Home Health Home health agency, Mountlake Terrace, WA, CCN 507099
  • CHI Franciscan Health at Home Home health agency, University Place, WA, CCN 507124
  • Puget Sound Home Health Home health agency, Tacoma, WA, CCN 507101
  • St Joseph Medical Center Hospital, Tacoma, WA, CCN 500108
  • St Anthony Hospital Hospital, Gig Harbor, WA, CCN 500151
  • St Michael Medical Center Hospital, Silverdale, WA, CCN 500039
  • Tacoma General Allenmore Hospital Hospital, Tacoma, WA, CCN 500129
  • St Clare Hospital Hospital, Lakewood, WA, CCN 500021
  • Heron'S Key Nursing home, Gig Harbor, WA, CCN 505531

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL36009SCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Franciscan Medical Group CurrentSince Aug 21, 2016 Accepting new patients
Franciscan Medical Group Family Medicine CurrentSince Aug 21, 2016 Accepting new patients
Franciscan Medical Group Family Medicine Past Accepting new patients

Locations

11511 Canterwood Blvd
Ste 320
Gig Harbor, WA 98332
Phone (253) 857-1350

11307 Bridgeport Way SW
Ste 200
Lakewood, WA 98499
Phone (253) 985-6688

1812 S J St
Ste 120
Tacoma, WA 98405
Phone (253) 428-2200

Interoperability endpoints

  • Direct secure messaging: vlibre197748@fhsce.catholichealth.net

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.

Hospital & facility affiliations 12

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": "1371600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1750720165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11511 CANTERWOOD BLVD STE 320",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983325813",
            "telephone_number": "253-857-1350",
            "fax_number": "253-857-1399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11511 CANTERWOOD BLVD STE 320",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983325813",
            "telephone_number": "253-857-1350",
            "fax_number": "253-857-1399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBRE",
        "first_name": "VANSON",
        "middle_name": "REYES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-19",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "LL36009",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60596361",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2067092",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vlibre197748@fhsce.catholichealth.net",
            "affiliation": "Y",
            "affiliationName": "Franciscan Medical Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "11511 Canterwood Blvd Ste 320",
            "city": "Gig Harbor",
            "state": "WA",
            "country_code": "US",
            "postal_code": "983325813",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gig Harbor, WA

Sources for this page

Verify at the official NPI Registry.