Individual provider Active NPI

Cathy E Liesner, MD

  • Gynecology Physician
  • Kettering, OH
National Provider Identifier
1104883537
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
35051994L Issued in OH
Practice address
3533 Southern Blvd
Ste 4600
Kettering, OH 45449-1273
Phone
(937) 296-0167
Fax
(937) 297-2330
NPI assigned
Apr 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 35051994L OH Primary

Addresses

Primary practice location

3533 Southern Blvd
Ste 4600
Kettering, OH 45449-1273

Mailing address

3533 Southern Blvd
Ste 4600
Kettering, OH 45449-1273
Phone (937) 296-0167

Other identifiers 2

IdentifierTypeStateIssuer
0589144MedicaidOH
000000009392OtherANTHEM PIN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cliesner179095@direct.ketteringhealth.org
FHIR URL https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20100827000561 OH Practitioner - Obstetrics/Gynecology 3678697638 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35051994LOHMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kettering Independent Medical Group Inc CurrentSince Dec 29, 2022 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

3533 Southern Blvd
Ste 4600
Kettering, OH 45429
Phone (932) 296-0167

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1104883537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD",
            "address_2": "STE 4600",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454491273",
            "telephone_number": "937-296-0167",
            "fax_number": "937-297-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3533 SOUTHERN BLVD",
            "address_2": "STE 4600",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454491273",
            "telephone_number": "937-296-0167",
            "fax_number": "937-297-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIESNER",
        "first_name": "CATHY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-28",
        "last_updated": "2023-03-07",
        "certification_date": "2022-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "OH",
            "license": "35051994L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0589144",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000009392",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cliesner179095@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd",
            "address_2": "Ste 4600",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454491273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3533 Southern Blvd",
            "address_2": "Ste 4600",
            "city": "Kettering",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454491273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.