Active NPI
Brent Dalee Libby, MD
- Diagnostic Radiology Physician
- Jacksonville, FL
National Provider Identifier
1821078346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 0101232281
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101232281 | VA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beaufort Jasper Hampton Comprehensive Health Services, Inc. | Current | Accepting new patients | |
| Beaufort Jasper Hampton Comprehensive Health Services, Inc | Current | 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
- 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.
-
- Federally Qualified Health Center (FQHC)
- Ridgeland, SC
- NPI 1649276148
-
- Federally Qualified Health Center (FQHC)
- Varnville, SC
- NPI 1073318259
-
- Diagnostic Radiology Physician
- Cincinnati, OH
- NPI 1588654610
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2010; 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.