Active NPI
Lori A Leaseburge, MD
- Obstetrics Physician
- Jacksonville, FL
National Provider Identifier
1275628455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics Physician
- License
- ME93918
- Practice address
- 1891 Beach Blvd
Suite 200
Jacksonville, FL 32250-2644 - Phone
- (904) 249-3743
- Fax
- (904) 249-2047
- NPI assigned
- Oct 4, 2006
- Last updated
- Nov 1, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics Physician | 207VX0000X | ME93918 | FL | Primary |
Addresses
Primary practice location
1891 Beach Blvd
Suite 200
Jacksonville, FL 32250-2644
Mailing address
1891 Beach Blvd
Suite 200
Jacksonville, FL 32250-2644
Phone (904) 249-3743
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 273607100 | Medicaid | FL |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Obstetrics/Gynecology
- Education
- JC Edwards School of Medicine, Marshall University, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1891 Beach Blvd
Suite 200
Jacksonville, FL 32250-2644
Phone (904) 249-3743
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME93918 | FL | MD | Obstetrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cleveland W Randolph, Jr, MD, PA | Current | Accepting new patients | |
| Florida Hospital Medical Group Inc | Past | Accepting new patients |
Locations
1891 Beach Blvd
Ste 200
Jax Bch, FL 32250
Phone (904) 249-3743
Interoperability endpoints
- drrandolphsagelessandwellness.lorileaseburge@126165.advancedmd-direct.com
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.
-
dba Dr. Randolph's Ageless & Wellness Medical Center
- Specialist
- Jacksonville Beach, FL
- NPI 1497808182
-
dba Rothman Orthopaedics AdventHealth Medical Group at Minneola
- Prosthetic/Orthotic Supplier
- Minneola, FL
- NPI 1285591545
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Baptist Medical Center Nassau
- General Acute Care Hospital
- Fernandina Beach, FL
- NPI 1518024462
-
- General Acute Care Hospital
- Jacksonville Beach, FL
- NPI 1821155912
-
- General Acute Care Hospital
- St Augustine, FL
- NPI 1144211020
-
dba Baptist Medical Center
- General Acute Care Hospital
- Jacksonville, FL
- NPI 1578620449
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320105600000",
"number": "1275628455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1891 BEACH BLVD",
"address_2": "SUITE 200",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322502644",
"telephone_number": "904-249-3743",
"fax_number": "904-249-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1891 BEACH BLVD",
"address_2": "SUITE 200",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322502644",
"telephone_number": "904-249-3743",
"fax_number": "904-249-2047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEASEBURGE",
"first_name": "LORI",
"middle_name": "A",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2011-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "207VX0000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Obstetrics",
"state": "FL",
"license": "ME93918",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "273607100",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
- Learning Basics Inc
- Learning Loft
- Jillian Marie Leary, APRN
- Kimberly Monique Leary, PH.D.
- Terrance Christopher Leary, DDS
- Tina A Leasure, CRNA
- Nekita Leatherwood, CRPS
- Daniel Joseph Leavins, PA-C
- Leavitt Medical Associates of Florida Inc (Advanced Dermatology and Cosmetic Surgery)
- Leavitt Medical Associates of Florida Inc (Advanced Dermatology)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.