James G Liesen, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2008032320 Issued in MO

Practice address

1195 N Oakland Ave
Suite 2
Bolivar, MO 65613-8095

Phone

(417) 777-2121

Fax

(417) 777-2854

NPI assigned

Jul 19, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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.

• Citizens Memorial Healthcare

  • Surgery Physician
  • Bolivar, MO
  • NPI 1568566131

  Pediatrics

  Medicare reassignment NPD
• Citizens Memorial Healthcare

  • Rural Health Clinic/Center
  • Willard, MO
  • NPI 1568127397
  NPD
• CH Allied Services, Inc.

  • General Acute Care Hospital
  • Columbia, MO
  • NPI 1902817844
  NPD (past)
• Citizens Memorial Hospital District

  • General Acute Care Hospital
  • Bolivar, MO
  • NPI 1003981549
  NPD (past)
• Tiger Pediatrics LLC

  • Pediatrics Physician
  • Columbia, MO
  • NPI 1871872770
  NPD (past)
• Southeast Iowa Regional Medical Center, Inc.

  • General Practice Physician
  • West Burlington, IA
  • NPI 1164433884
  NPD (past)

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487808000000",
    "number": "1003815291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N OAKLAND AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656133011",
            "telephone_number": "417-328-6501",
            "fax_number": "417-328-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 N OAKLAND AVE",
            "address_2": "SUITE 2",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656138095",
            "telephone_number": "417-777-2121",
            "fax_number": "417-777-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIESEN",
        "first_name": "JAMES",
        "middle_name": "G",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2017-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WV",
            "license": "2101",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2008032320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810002037",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chad David Law, D.O.
• Joshua Charles Layman, PT, PHD
• Bethany S Lemmon, PA-C
• Steven Glenn Lesh, PT
• Lester E Cox Medical Centers
• Melissa Lightfoot
• Lighthouse of Hope, LLC
• Greg Link, DO
• Tammy Lynn Lippincott, L.M.T
• Wanita Lister, FNP-C

• Pediatrics Physician in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.