Active NPI
Jennifer E Leibold, PA-C
- Physician Assistant
- Dayton, OH
National Provider Identifier
1962710103
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 50001562
- Practice address
- 5491 Far Hills Ave
Dayton, OH 45429-2325 - Phone
- (937) 436-5763
- NPI assigned
- Sep 22, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 50.001562 | OH | |
| Personal Care Attendant | 3747P1801X | |||
| Physician Assistant | 363A00000X | 50001562 | OH | Primary |
Addresses
Primary practice location
5491 Far Hills Ave
Dayton, OH 45429-2325
Mailing address
1430 Oak CT Ste 100
Beavercreek, OH 45430-1064
Phone (937) 404-1101
Other practice location 1
6210 Brandt Pike Ste 102
Huber Heights, OH 45424-4019
Phone (937) 236-8630
Other practice location 2
9150 N Main St Ste 100
Englewood, OH 45415-1123
Phone (937) 771-3039
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0104799 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
4501 Lyons Rd
Miamisburg, OH 45342-6444
Phone (844) 255-2225
6210 Brandt Pike
Huber Heights, OH 45424-4019
Phone (937) 236-8630
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50001562 | OH | MD | Physician Assistant |
| 50.001562 | OH | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Urgent Care Specialists, LLC | Past | Accepting new patients |
Interoperability endpoints
- jennifer.leibold.1@22702.direct.athenahealth.com
Organizations & group practices 3
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.
-
dba Hometown Urgent Care
- Urgent Care Clinic/Center
- Huber Heights, OH
- NPI 1114957123
-
- Sports Medicine (Orthopaedic Surgery) Physician
- Dayton, OH
- NPI 1851423545
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Kettering Health Dayton
- General Acute Care Hospital
- Dayton, OH
- NPI 1053339507
-
dba Kettering Health Main Campus
- General Acute Care Hospital
- Kettering, OH
- NPI 1043233984
-
- General Acute Care Hospital
- Dayton, OH
- NPI 1073688354
-
- General Acute Care Hospital
- Springfield, OH
- NPI 1538304050
-
- General Acute Care Hospital
- Troy, OH
- NPI 1184638942
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1772668800000",
"number": "1962710103",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1430 OAK CT STE 100",
"city": "BEAVERCREEK",
"state": "OH",
"postal_code": "454301064",
"telephone_number": "937-404-1101",
"fax_number": "937-404-1210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5491 FAR HILLS AVE",
"city": "DAYTON",
"state": "OH",
"postal_code": "454292325",
"telephone_number": "937-436-5763"
}
],
"practiceLocations": [
{
"address_1": "6210 Brandt Pike Ste 102",
"address_purpose": "LOCATION",
"city": "Huber Heights",
"state": "OH",
"postal_code": "454244019",
"country_code": "US",
"telephone_number": "937-236-8630",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "9150 N Main St Ste 100",
"address_purpose": "LOCATION",
"city": "Englewood",
"state": "OH",
"postal_code": "454151123",
"country_code": "US",
"telephone_number": "937-771-3039",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEIBOLD",
"first_name": "JENNIFER",
"middle_name": "E",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-22",
"last_updated": "2026-03-05",
"certification_date": "2026-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OH",
"license": "50.001562",
"primary": false
},
{
"code": "3747P1801X",
"taxonomy_group": "",
"desc": "Technician, Personal Care Attendant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OH",
"license": "50001562",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0104799",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dayton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.