Erin E Leeseberg, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

02003470A Issued in IN

Practice address

482 S Landmark Ave
Bloomington, IN 47403-5000

Phone

(812) 355-3299

Fax

(812) 355-3290

NPI assigned

Apr 11, 2007

Last updated

Jun 3, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Erin E Leeseberg Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Eagle Physicians and Associates PA

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  • Greensboro, NC
  • NPI 1609070648
  NPD (past)

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1528281169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S EAGLESON AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474055000",
            "telephone_number": "812-855-4011",
            "fax_number": "812-355-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474035000",
            "telephone_number": "812-355-3299",
            "fax_number": "812-355-3290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEESEBERG",
        "first_name": "ERIN",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2022-06-03",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2007-01098",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "02003470A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200941160",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ERIN",
            "last_name": "LEESEBERG",
            "middle_name": "E",
            "credential": "DO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Judith Lee, BCBA
• Luna Lee
• Samantha Brooke Lee
• Susan K Lee, NP
• Sarah Leeds, PHARM.D.
• Legacy Healthcare Services Inc.
• Legacycare Home Health, LLC
• Ashley Nichole Lehman, MA, BCBA
• Barbara Anne Lehr, CLCD
• Katelyn Leigh

• Family Medicine Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.