ADVANCED FAMILY MEDICAL CLINIC LIBERTY
NPI 1023545241
Clinic/Center - Rural Health in Liberty, KY
About Advanced Family Medical Clinic Liberty NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ADVANCED FAMILY MEDICAL CLINIC LIBERTY (NPI 1023545241) is a healthcare organization registered as a rural health in Liberty, Kentucky and active in the NPI registry since May 2017. The organization holds a CLIA Waiver certificate valid through July 28, 2027 and lists Khursheed Akram Siddiqui, Medical Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Advanced Family Medical Clinic Liberty is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
11Medicare enrollment records show 11 clinicians reassign Medicare billing to Advanced Family Medical Clinic Liberty, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 5 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 4
Clinicians, nearest first (11)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 18D2169807
Advanced Family Medical Clinic Of Liberty · Liberty, KYFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Advanced Family Medical Clinic Liberty's NPI number?
The NPI number for Advanced Family Medical Clinic Liberty is 1023545241. It was assigned to this organization in the NPPES registry on May 18, 2017.
Where is Advanced Family Medical Clinic Liberty located?
Advanced Family Medical Clinic Liberty is located at 84 Hustonville St, Liberty, KY 42539. The listed phone number is (606) 706-7473.
What is Advanced Family Medical Clinic Liberty's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Advanced Family Medical Clinic Liberty enrolled in Medicare?
Yes. Advanced Family Medical Clinic Liberty is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Advanced Family Medical Clinic Liberty?
According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 4 Medicare specialties reassign their Medicare billing to Advanced Family Medical Clinic Liberty. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (6), Family Practice (3) and Anesthesiology (1). Of these, 2 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Advanced Family Medical Clinic Liberty hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 18D2169807) is associated with this NPI, valid through July 28, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Advanced Family Medical Clinic Liberty accept?
Health plans from Anthem Blue Cross and Blue Shield list Advanced Family Medical Clinic Liberty as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Advanced Family Medical Clinic Liberty was last updated on January 16, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Advanced Family Medical Clinic Liberty · NPI 1023545241
Rural Health organization in Liberty, Kentucky. Organization record, active in the CMS NPPES registry since May 18, 2017.
## Identity
- **NPI:** 1023545241 (Entity type: Organization)
- **Enumerated:** May 18, 2017
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Organization subpart:** No
- **Authorized official:** Khursheed Siddiqui, MEDICAL DIRECTOR
## Practice location
- **Address:** 84 HUSTONVILLE ST, Liberty, KY 42539-3469
- **Phone:** (606) 706-7473 · **Fax:** (606) 303-9170
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 11 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (6), Family Practice (3), Anesthesiology (1); 2 practice at this address and 5 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 16, 2026
- **Other identifiers:** Medicaid 7100503210 (KY)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1023545241) · Data from the CMS NPPES public registry.