Glen R. Liesegang, M. D.
Individual provider Active NPI Family Medicine Physician · Patterson, NC
NPI 1174584866 · NPPES record last updated Jun 18, 2012
Key facts
- NPI
- 1174584866
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 31569 (NC)
- Practice address
- 1345 Highway 268
Patterson, NC 28661 - Phone
- (828) 754-6850
- Fax
- (828) 758-3214
- NPI assigned
- Mar 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Kentucky College of Medicine, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Appalachian Primary Care PLLC
Practice addresses (Care Compare)
107 Haywood Park Dr
Clyde, NC 28721-4405
Phone (828) 647-0647
237 Longvue Dr
Suite B
Boone, NC 28607-5070
Phone (828) 647-0647
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- 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 |
|---|---|---|---|---|
| I20100804000973 | NC | Practitioner - Family Practice |
8426181934 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| High Country Community Health | Current |
Accepting new patients | |
| High Country Community Health | Current | Accepting new patients | |
| Blowing Rock Medical Clinic PR | Current | Accepting new patients | |
| High Country Community Health | Family Medicine | Current |
Accepting new patients |
| Appalachian Primary Care, PLLC | Current |
Accepting new patients | |
| High Country Community Health | Current |
Accepting new patients | |
| Caldwell Memorial Hospital, Inc. | Current | Accepting new patients |
Locations
237 Longvue Dr
Ste B
Boone, NC 28607
Phone (828) 264-6262
160 Den-Mac Dr
Boone, NC 28607
Phone (828) 262-3886
240 Highway 105 Ext
Ste 100
Boone, NC 28607
Phone (828) 264-7311
935 State Farm Rd
Boone, NC 28607
Phone (828) 262-3886
87 Medical Park Dr
Brevard, NC 28712
Phone (828) 237-8001
107 Haywood Park Dr
Clyde, NC 28721
Phone (828) 237-8001
9 Edgewood Ave
Franklin, NC 28734
Phone (828) 237-8001
301 E Meeting St
Ste 101
Morganton, NC 28655
Phone (828) 608-0800
Interoperability endpoints
- glen.liesegang.1@25542.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 31569 | NC | Yes |
Addresses
Primary practice location
1345 Highway 268
Patterson, NC 28661
Mailing address
PO Box 319
Patterson, NC 28661-0319
Phone (828) 754-6850
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8951919 | Medicaid | NC | |
| 51919 | Other | NC | BCBS |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2012. 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.