Individual provider Active NPI

Bryan Lesniewicz, PA-C

  • Physician Assistant
  • Glen Allen, VA
National Provider Identifier
1760163133
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1185614 Issued in VA
Practice address
10187 Brook Rd
Glen Allen, VA 23059-6508
Phone
(540) 523-8080
NPI assigned
Jul 28, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1185614 VA Primary

Addresses

Primary practice location

10187 Brook Rd
Glen Allen, VA 23059-6508

Mailing address

2590 Chartstone Dr
Midlothian, VA 23113-9632
Phone (804) 245-1287

Other practice location 1

5673 Airport Rd
Roanoke, VA 24012-1119
Phone (540) 523-8080

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240205002911 VA Practitioner - Physician Assistant 3173966397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Intercept Youth Services IncGroup PAC ID 2466748744, 4 clinicians

Practice addresses (Care Compare)

5673 Airport Rd
Roanoke, VA 24012-1119
Phone (540) 523-8055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1185614VAMDPhysician Assistant

Organizations & group practices 1

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": "1690502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1760163133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2590 CHARTSTONE DR",
            "city": "MIDLOTHIAN",
            "state": "VA",
            "postal_code": "231139632",
            "telephone_number": "804-245-1287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10187 BROOK RD",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230596508",
            "telephone_number": "540-523-8080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5673 Airport Rd",
            "address_purpose": "LOCATION",
            "city": "Roanoke",
            "state": "VA",
            "postal_code": "240121119",
            "country_code": "US",
            "telephone_number": "540-523-8080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LESNIEWICZ",
        "first_name": "BRYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-28",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "1185614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Allen, VA

Sources for this page

Verify at the official NPI Registry.