Individual provider Active NPI

Brent Dalee Libby, MD

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1821078346
Registry record updated Feb 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
0101232281 Issued in VA
Practice address
Attn: Medical Staff Services BLDG. H 2005 Knight Lane
Navy Medicine Support Command
Jacksonville, FL 32212-0140
Phone
(904) 542-7200
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 0101232281 VA Primary

Addresses

Primary practice location

Attn: Medical Staff Services BLDG. H 2005 Knight Lane
Navy Medicine Support Command
Jacksonville, FL 32212-0140

Mailing address

7 Pleasant Place CT
Beaufort, SC 29907-1187
Phone (843) 524-0743

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170718002375 SC Practitioner - Diagnostic Radiology 1557590593 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101232281VAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc. CurrentSince May 10, 2017 Accepting new patients
Beaufort Jasper Hampton Comprehensive Health Services, Inc CurrentSince May 10, 2017 Accepting new patients
Proscan Radiology, LLC Diagnostic Radiology Past Accepting new patients

Locations

721 Okatie Hwy
Okatie, SC 29909

721 N Okatie Hwy
Ridgeland, SC 29936
Phone (843) 987-7492

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EICIBD

Organizations & group practices 4

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265241600000",
    "number": "1821078346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 PLEASANT PLACE CT",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "299071187",
            "telephone_number": "843-524-0743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ATTN: MEDICAL STAFF SERVICES BLDG. H 2005 KNIGHT LANE",
            "address_2": "NAVY MEDICINE SUPPORT COMMAND",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322120140",
            "telephone_number": "904-542-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBBY",
        "first_name": "BRENT",
        "middle_name": "DALEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2010-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "VA",
            "license": "0101232281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.