Individual provider Active NPI

Brendalynn Ijeoma-Ibe Lieberman, NP

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1912250242
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5012382 Issued in NC
Practice address
10850 Providence Rd Ste 1260
Charlotte, NC 28277-2684
Phone
(248) 766-5786
NPI assigned
Oct 24, 2012
Last updated
Apr 29, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5012382 NC Primary

Addresses

Primary practice location

10850 Providence Rd Ste 1260
Charlotte, NC 28277-2684

Mailing address

10850 Providence Rd Ste 1260
Charlotte, NC 28277-2684
Phone (248) 766-5786

Other identifiers 1

IdentifierTypeStateIssuer
4704249739OtherMILICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230424000884 NC Practitioner - Nurse Practitioner 3072745371 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uwh of the Carolinas PLLCGroup PAC ID 0042448169, 329 clinicians

Practice addresses (Care Compare)

3125 Springbank LN
Suite B
Charlotte, NC 28226-3379
Phone (704) 341-1103

Merit-based Incentive Payment System (MIPS)

Final score
88.25 of 100Reported as group
Quality
82.32
Promoting interoperability
100
Improvement activities
40
Cost
78.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
5012382NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Uwh of the Carolinas, PLLC CurrentSince May 1, 2023 Accepting new patients
Planned Parenthood of Michigan Past Accepting new patients
Whap, PA Past Accepting new patients

Locations

3125 Springbank Ln
Ste B
Charlotte, NC 28226
Phone (704) 341-1103

1806 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 768-3632

Interoperability endpoints

  • Direct secure messaging: brendalynn.lieberman.1@7773.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1351036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1912250242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10850 PROVIDENCE RD STE 1260",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772684",
            "telephone_number": "248-766-5786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10850 PROVIDENCE RD STE 1260",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772684",
            "telephone_number": "248-766-5786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "BRENDALYNN",
        "middle_name": "IJEOMA-IBE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-24",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5012382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "4704249739",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.