Individual provider Active NPI

Leslie Romersberger

  • Physician Assistant
  • Pontiac, IL
National Provider Identifier
1104153550
Registry record updated Jan 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085003656 Issued in IL
Practice address
2500 W Reynolds St
Pontiac, IL 61764-9774
Phone
(815) 844-5343
NPI assigned
Nov 5, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085003656 IL Primary

Addresses

Primary practice location

2500 W Reynolds St
Pontiac, IL 61764-9774

Mailing address

2500 W Reynolds St
Pontiac, IL 61764-9774

Other identifiers 1

IdentifierTypeStateIssuer
833230OtherMEDICARE GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20190719001271 FL Practitioner - Physician Assistant 3173662392 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesiscare USA of Florida LLCGroup PAC ID 9830082882, 172 clinicians

Practice addresses (Care Compare)

1419 SE 8TH Ter
Cape Coral, FL 33990-3213
Phone (239) 772-3202

4571 Colonial Blvd
Fort Myers, FL 33966-1156

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085003656ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Genesiscare USA of Florida LLC CurrentSince Jul 8, 2019 Accepting new patients
Genesiscare USA of Florida LLC CurrentSince Jul 8, 2019 Accepting new patients
Genesiscare USA of Florida LLC Past Accepting new patients

Locations

1419 SE 8th Ter
Cape Coral, FL 33990
Phone (239) 772-3202

4571 Colonial Blvd
Ste 210
Fort Myers, FL 33966
Phone (239) 274-7600

13770 Plantation Rd
Ste 2
Fort Myers, FL 33912
Phone (239) 275-0728

4571 Colonial Blvd
Ste 110
Fort Myers, FL 33966
Phone (239) 226-2727

730 Goodlette Rd
Ste 201
Naples, FL 34102
Phone (239) 262-1119

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1257379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263427200000",
    "number": "1104153550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 W REYNOLDS ST",
            "city": "PONTIAC",
            "state": "IL",
            "postal_code": "617649774",
            "telephone_number": "815-844-5343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMERSBERGER",
        "first_name": "LESLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-05",
        "last_updated": "2010-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085003656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "833230",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontiac, IL

Sources for this page

Verify at the official NPI Registry.