NPIMap

Individual provider Active NPI

Leslie P Liegel, PAC

  • Medical Physician Assistant
  • Madison, WI
National Provider Identifier
1922084649
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
819-23 Issued in WI
Practice address
8814 Timber Wolf TRL
Madison, WI 53717-2721
Phone
(608) 827-8358
NPI assigned
Dec 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 819-23 WI Primary

Addresses

Primary practice location

8814 Timber Wolf TRL
Madison, WI 53717-2721

Mailing address

8814 Timber Wolf TRL
Madison, WI 53717-2721

Other identifiers 4

IdentifierTypeStateIssuer
P00144568OtherWIRAILROAD MEDICARE PROV #
70OtherWIDEANCARE PROV #
1009390OtherWIPHYS PLUS PROV #
42950700MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Healthcare of Wi Inc Past Accepting new patients
SSM Health Treatment and Recovery Center Past Accepting new patients
SSM Health Care of Wisconsin, Inc. Past Accepting new patients
SSM Healthcare of Wi Inc Past Accepting new patients
Advanced Pain Management SC Past Accepting new patients
SSM Health Care of Wisconsin Inc Past Accepting new patients

Organizations & group practices 6

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": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1922084649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8814 TIMBER WOLF TRL",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8814 TIMBER WOLF TRL",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537172721",
            "telephone_number": "608-827-8358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEGEL",
        "first_name": "LESLIE",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-15",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "819-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PROV #",
            "identifier": "P00144568",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEANCARE PROV #",
            "identifier": "70",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYS PLUS PROV #",
            "identifier": "1009390",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42950700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.