Jacob Michael Kisiel, DO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

R4575 Issued in NH

Practice address

1 Medical Center Dr
Lebanon, NH 03756-1000

Phone

(603) 650-5000

NPI assigned

May 24, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1653350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751587200000",
    "number": "1952049520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037560001",
            "telephone_number": "603-650-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5515 Peach St",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165092603",
            "country_code": "US",
            "telephone_number": "814-868-2476",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISIEL",
        "first_name": "JACOB",
        "middle_name": "MICHAEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-24",
        "last_updated": "2025-07-04",
        "certification_date": "2025-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "OT021611",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NH",
            "license": "R4575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Platanitis Kinsman, MD
• Joseph Kirgis, OD
• Elaine T. Kiriakopoulos, MD
• Kathryn Brawley Kirkland, M.D.
• Joshua Daniel Kirschenbaum
• Paul Henry Kispert, M.D.
• Rachel Kivela, RN
• Scott Klass
• Erin Rachel Klein
• Samuel Benjamin Klein, M.D.

• Student in an Organized Health Care Education/Training Program in Lebanon, NH
• Providers in Lebanon, NH by specialty
• Student in an Organized Health Care Education/Training Program in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.