Individual provider Active NPI

Julie Anne Leister, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Roseburg, OR
National Provider Identifier
1902569320
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
202112008NP-PP Issued in OR
Practice address
3031 NE Stephens St
Roseburg, OR 97470-6237
Phone
(541) 229-7038
Fax
(541) 464-4474
NPI assigned
Oct 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 202112008NP-PP OR Primary

Addresses

Primary practice location

3031 NE Stephens St
Roseburg, OR 97470-6237

Mailing address

3031 NE Stephens St
Roseburg, OR 97470-6237
Phone (541) 229-7038

Other identifiers 1

IdentifierTypeStateIssuer
202112008NP-PPOtherOROREGON NURSING BOARD LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20211119001244 OR Practitioner - Nurse Practitioner 4486043031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Umpqua Health Newton Creek LLCGroup PAC ID 4284915141, 9 clinicians

Practice addresses (Care Compare)

3031 NE Stephens St
Roseburg, OR 97470-6237
Phone (541) 229-7038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
202112008NP-PPORMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Umpqua Health Newton Creek, LLC CurrentSince Nov 1, 2021 Accepting new patients

Locations

3031 NE Stephens St
Roseburg, OR 97470
Phone (541) 229-7038

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JCEJBD

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": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1902569320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3031 NE STEPHENS ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974706237",
            "telephone_number": "541-229-7038",
            "fax_number": "541-464-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3031 NE STEPHENS ST",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974706237",
            "telephone_number": "541-229-7038",
            "fax_number": "541-464-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEISTER",
        "first_name": "JULIE",
        "middle_name": "ANNE",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "202112008NP-PP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON NURSING BOARD LICENSE",
            "identifier": "202112008NP-PP",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseburg, OR

Sources for this page

Verify at the official NPI Registry.