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MELISSA LIEBOLD PA-C
NPI 1235725672
Physician Assistant in Port Jefferson Station, NY

Active since December 20, 2020PECOS EnrolledAccepts Medicare Assignment
1500 ROUTE 112 STE A, PORT JEFFERSON STATION, NY 11776(631) 265-4200 Get Directions Write a Review

NPPES record last updated: March 1, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 11, 2022, Feb 14, 2021, Dec 20, 2020 (3 updates tracked since 2020).

About Melissa Liebold Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MELISSA LIEBOLD PA-C (NPI 1235725672) is an individual physician assistant in Port Jefferson Station, New York, licensed in New York (026336) and active in the NPI registry since December 2020. She is enrolled in Medicare PECOS, is affiliated with John T Mather Memorial Hospital Of Port Jefferson, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1235725672
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMELISSA LIEBOLDCredential: PA-C
Location Address1500 ROUTE 112 STE APort Jefferson Station, NY 11776-8055
Mailing Address91 Dorchester RdLake Ronkonkoma, NY 11779-1616 · (631) 338-0711
Phone(631) 265-4200
Sole ProprietorYes
Medical School CMSOtherGraduated 2021
Enumeration DateDecember 20, 2020
Last NPPES UpdateMarch 1, 20243 updates tracked since enumeration
NPPES CertifiedMarch 1, 2024
✔ NPI 1235725672 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 026336
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
1500 ROUTE 112 STE A, Port Jefferson Station, NY 11776
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Melissa Liebold Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID547669012
PECOS Enrollment IDI20210603001564
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 10

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
256 services182 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
174 services138 patients
Insertion of needle into vein for collection of blood sample 36415
This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.
77 services64 patients
Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report 93000
An electrocardiogram (ECG) is a non-invasive test that records your heart's electrical activity. Using 12 leads attached to your body, it captures data to help identify heart conditions. A doctor interprets the results and provides a report.
51 services48 patients
Urinalysis, manual test 81002
A urinalysis is a simple, non-invasive test that checks the urine for various elements such as sugar, protein, and signs of infection. It can help detect many common conditions, including kidney disease and diabetes. The manual test involves a lab technician examining a urine sample.
41 services37 patients
Telephone medical discussion with physician, 11-20 minutes 99442
This is a service where you have a phone conversation with your doctor for 11-20 minutes. It's used for discussing health concerns, reviewing test results, or managing ongoing conditions. It's a convenient way to receive medical advice without an in-person visit.
26 services21 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

John T Mather Memorial Hospital Of Port Jefferson

Acute Care Hospitals · Port Jefferson, NY
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number330185
Location75 North Country RoadPort Jefferson, NY 11777 · Suffolk County
Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 11776 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$105.06 typical visit price
range $67.40 – $203.53
Typical copayment $26.26 (range $16.85 – $50.88)
Most-billed visit code 99203
Established Patient
$83.44 typical visit price
range $21.66 – $164.45
Typical copayment $20.86 (range $5.41 – $41.11)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. VARVARA BORYUSHKINA MD
Internal Medicine
1500 ROUTE 112 STE A
PORT JEFFERSON STATION, NY 11776
Suffolk County (631) 686-1414

Frequently 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 Melissa Liebold's NPI number?

The NPI number for Melissa Liebold is 1235725672. It was assigned to this individual provider in the NPPES registry on December 20, 2020.

Where is Melissa Liebold located?

Melissa Liebold practices at 1500 Route 112 Ste A, Port Jefferson Station, NY 11776. The listed phone number is (631) 265-4200.

What is Melissa Liebold's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Melissa Liebold enrolled in Medicare?

Yes. Melissa Liebold is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Melissa Liebold affiliated with any hospitals?

According to CMS data, Melissa Liebold is affiliated with John T Mather Memorial Hospital Of Port Jefferson.

When was this NPI record last updated?

The NPPES record for Melissa Liebold was last updated on March 1, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.