Kenneth Paul Libre, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

328690-1205 Issued in UT

Practice address

10160 E Highway 210
Suite 1, Goldminer's Daughter Lodge
Alta, UT 84092-8072

Phone

(801) 742-2273

NPI assigned

Dec 23, 2005

Last updated

Dec 21, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency MedicineAlso: Family Practice

Education

Geisel School of Medicine at Dartmouth, 1994

Medicare assignment

May accept Medicare assignment

Group practices

Community Health Centers IncGroup PAC ID 5991698169, 39 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/ACFCAA
• Direct secure messaging: kenneth.libre.1@13794.direct.athenahealth.com
• Direct secure messaging: kenneth.libre@chcsl.eclinicaldirectplus.com

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.

• Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • West Valley City, UT
  • NPI 1952505117

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Alta Medical Services PC

  dba Alta Medical Clinic

  • Urgent Care Clinic/Center
  • Alta, UT
  • NPI 1740348556
  Medicare reassignment Authorized official
• Canyon Care LLC

  • Family Medicine Physician
  • Alta, UT
  • NPI 1417509860
  NPD Authorized official
• Community Health Centers, Inc.

  dba 72nd Street Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Midvale, UT
  • NPI 1073611364

  Family Medicine

  NPD
• Tooele Hospital Corporation

  dba Mountain West Medical Center

  • General Acute Care Hospital
  • Tooele, UT
  • NPI 1124090659
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services Inc

  dba Intermountain Health Alta View Hospital

  • General Acute Care Hospital
  • Sandy, UT
  • NPI 1962412486
  Care Compare affiliation

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356048000000",
    "number": "1801873534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8072",
            "city": "ALTA",
            "state": "UT",
            "postal_code": "840928072",
            "telephone_number": "801-742-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10160 E HIGHWAY 210",
            "address_2": "SUITE 1, GOLDMINER'S DAUGHTER LODGE",
            "city": "ALTA",
            "state": "UT",
            "postal_code": "840928072",
            "telephone_number": "801-742-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBRE",
        "first_name": "KENNETH",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2012-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "328690-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alta Medical Services PC (Alta Medical Clinic)
• Alta Sports Therapy
• Canyon Care LLC
• Madeline Rose Halperin

• Family Medicine Physician in Alta, UT
• Providers in Alta, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.