NPIMap

Individual provider Active NPI

Lesley J Kieffer, DO

  • Family Medicine Physician
  • De Pere, WI
National Provider Identifier
1053638916
Registry record updated Aug 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
56637-21 Issued in WI
Practice address
1800 Lawrence Dr
De Pere, WI 54115-9108
Phone
(920) 983-3220
NPI assigned
Apr 30, 2010
Last updated
Aug 24, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 56637-21 WI Primary

Addresses

Primary practice location

1800 Lawrence Dr
De Pere, WI 54115-9108

Mailing address

PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7226

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130809000733 WI Practitioner - Family Practice 1658513221 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

710 Riverside Dr
Waupaca, WI 54981-1941
Phone (715) 256-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
56637-21WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare, Incorporated CurrentSince Nov 30, 2020 Accepting new patients

Locations

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

600 N Westhaven Dr
Oshkosh, WI 54904
Phone (920) 237-5000

800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000

710 Riverside Dr
Waupaca, WI 54981
Phone (715) 256-3000

Interoperability endpoints

  • Direct secure messaging: lkieffer63783@direct.thedacare.org

Organizations & group practices 2

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.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1053638916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22487",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543052487",
            "telephone_number": "920-445-7226",
            "fax_number": "920-445-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 LAWRENCE DR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541159108",
            "telephone_number": "920-983-3220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIEFFER",
        "first_name": "LESLEY",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-30",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "56637-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Pere, WI

Sources for this page

Verify at the official NPI Registry.