Andrew T Leebolt, DO
Individual provider Active NPI Family Medicine Physician · Lillington, NC
NPI 1104486885 · NPPES record last updated Apr 29, 2025
Key facts
- NPI
- 1104486885
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5357 (TN)
- Practice address
- 215 Brightwater Drive
Lillington, NC 27546 - Phone
- (910) 892-1000
- NPI assigned
- Jun 16, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Edward Via Col of Osteo Medicine-Virginia Campus, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Western Virginia Regional Emergency Physicians LLC
Practice addresses (Care Compare)
58 Carrol St
Lebanon, VA 24266
Phone (276) 883-8000
Hospital & facility affiliations
- Smyth County Community Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.33 of 100
- Quality
- 83.8
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 75.12 of 100
- Quality
- 64.75
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240325002998 | TN | Practitioner - Family Practice | 5294158523 | Reassigns benefits to 2 organizations |
| I20240826001780 | VA | Practitioner - Emergency Medicine | 5294158523 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0102208637 | VA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Virginia Regional Emergency Physicians, LLC | Emergency Medicine | Current |
Accepting new patients |
| Blue Ridge Medical Management Corporation | Current | Accepting new patients | |
| Blue Ridge Medical Management Corporation | Current |
Accepting new patients | |
| Blue Ridge Medical Management Corporation | Family Medicine | Current |
Accepting new patients |
| Tri-Cities Regional Emergency Physicians, PC | Emergency Medicine | Current |
Accepting new patients |
Locations
1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451
1497 W Elk Ave
Ste 20
Elizabethton, TN 37643
Phone (423) 547-7380
800 S Mohawk Dr
Ste C
Erwin, TN 37650
Phone (423) 330-6177
400 N State of Franklin Rd
Johnson City, TN 37604
Phone (423) 431-1310
1019 W Oakland Ave
Ste 1
Johnson City, TN 37604
Phone (423) 915-5000
245 Medical Park Dr
Marion, VA 24354
Phone (276) 378-1000
100 15th St NW
Norton, VA 24273
Phone (276) 439-1000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 5357 | TN | |
| Emergency Medicine Physician | 207P00000X | 0102208637 | VA | |
| Family Medicine Physician | 207Q00000X | 0102208637 | VA | |
| Family Medicine Physician | 207Q00000X | 5357 | TN | Yes |
Addresses
Primary practice location
215 Brightwater Drive
Lillington, NC 27546
Mailing address
215 Brightwater Drive
Lillington, NC 27546
Phone (910) 892-1000
Other practice location 1
800 S Mohawk Dr Ste C
Erwin, TN 37650-2124
Phone (423) 735-0500
Other providers in Lillington, NC
- Stephanie Breanne Lane
- Ashley Darroch Lawson
- Kimberly Dawn Leaird
- Shannon Renee Lebakken
- Julia Ashton Ledgett
- Alina Leonhardt
- Alexandrea Elmore Lesnoff
- Eric Michael Levan
- Anna Finestone Leviere
- Lara Webb Liles
All providers in Lillington, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.