NPIMap

Individual provider Active NPI

Liezl G. Irisari, M.D.

  • Obstetrics & Gynecology Physician
  • Berlin, MD
National Provider Identifier
1851327001
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
230999 Issued in MA
Practice address
11107 Racetrack Rd
Berlin, MD 21811-3279
Phone
(410) 208-9761
Fax
(410) 208-9764
NPI assigned
Jun 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician 2088F0040X 230999 MA
Obstetrics & Gynecology Physician 207V00000X 230999 MA Primary

Addresses

Primary practice location

11107 Racetrack Rd
Berlin, MD 21811-3279

Mailing address

10026 Old Ocean City Blvd
Building #1
Berlin, MD 21811-1288
Phone (410) 641-9450

Other identifiers 1

IdentifierTypeStateIssuer
110076111AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20070917000143 MA Practitioner - Obstetrics/Gynecology 7315943297 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Berkshire Faculty Services IncGroup PAC ID 8224068424, 276 clinicians

Practice addresses (Care Compare)

71 Hospital Ave
North Adams, MA 01247-2504
Phone (413) 395-7694

725 N St
Pittsfield, MA 01201-4109
Phone (413) 447-2695

725 N Street Berkshire OB/GYN of
Mbu
Pittsfield, MA 01201-4109
Phone (413) 499-8570

780 S Main St
Suite 2
Great Barrington, MA 01230-2149
Phone (413) 447-2498

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10
Removal of the uterus1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Berkshire Faculty Services Inc CurrentSince Dec 7, 2020 Accepting new patients
Fairview Hospital CurrentSince Dec 7, 2020 Accepting new patients
Henry Heywood Memorial Hospital CurrentSince Sep 1, 2018 Accepting new patients
Henry Heywood Memorial Hospital CurrentSince Sep 1, 2018 Accepting new patients
Athol Memorial Hospital Incorporated CurrentSince Jul 1, 2019 Accepting new patients
Berkshire Medical Center, Inc Past Accepting new patients
Atlantic Immedicare LLC Past Accepting new patients
Monadnock Community Hospital PastSince Jan 1, 2020 Accepting new patients

Locations

2033 Main St
Athol, MA 01331
Phone (978) 249-1295

242 Green St
Gardner, MA 01440
Phone (978) 258-4734

250 Green St
Ste 107
Gardner, MA 01440
Phone (978) 630-5050

250 Green St
Gardner, MA 01440
Phone (978) 630-5050

780 S Main St
Ste 2
Gt Barrington, MA 01230
Phone (413) 447-2498

725 North St
Pittsfield, MA 01201
Phone (413) 447-2839

Interoperability endpoints

  • Direct secure messaging: liezlirisari@agh.allscriptsdirect.net
  • Direct secure messaging: liezlirisari@bfs.medalliesdirect.net

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1851327001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10026 OLD OCEAN CITY BLVD",
            "address_2": "BUILDING #1",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111288",
            "telephone_number": "410-641-9450",
            "fax_number": "410-641-9515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11107 RACETRACK RD",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218113279",
            "telephone_number": "410-208-9761",
            "fax_number": "410-208-9764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRISARI",
        "first_name": "LIEZL",
        "middle_name": "G.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-22",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2088F0040X",
            "taxonomy_group": "",
            "desc": "Urology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "MA",
            "license": "230999",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MA",
            "license": "230999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110076111A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, MD

Sources for this page

Verify at the official NPI Registry.