Douglas Jason Lieberman

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

812736 Issued in NV

Practice address

5523 S Eastern Ave
Las Vegas, NV 89119-2312

Phone

(702) 463-4050

Fax

(702) 463-7881

NPI assigned

Aug 15, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Impact Health PCGroup PAC ID 0941562664, 79 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bristol Hospital Hospital, Bristol, CT, CCN 070029

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Impact Health P.C.

  • Nurse Practitioner
  • Orange, CT
  • NPI 1730694316
  Medicare reassignment Care Compare group NPD

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

• Bristol Hospital Incorporated

  • General Acute Care Hospital
  • Bristol, CT
  • NPI 1619901642
  Care Compare affiliation

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548979200000",
    "number": "1942780382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 EARLY FROST AVE",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890522623",
            "telephone_number": "702-577-8176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5523 S EASTERN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891192312",
            "telephone_number": "702-463-4050",
            "fax_number": "702-463-7881"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "61 Bellevue Ave",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "CT",
            "postal_code": "060105815",
            "country_code": "US",
            "telephone_number": "860-589-1682",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIEBERMAN",
        "first_name": "DOUGLAS",
        "middle_name": "JASON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-15",
        "last_updated": "2019-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "ID",
            "license": "57640",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "008028",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NV",
            "license": "812736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Marie Woods Lide, PA-C
• Takar Lide
• Lie Charleston Smiles Dentistry, PC
• Wanni Lie
• Richard D Lieber, MD
• Rebecca A Liebert, APN
• Jonathan T Liebig, M.D.
• Michelle Lieder
• Spring Lieng
• Katerin Liens Cabrera

• Nurse Practitioner in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Nurse Practitioner in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2019; 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.