NPIMap

Individual provider Active NPI

Leslie W Jackson, MD

  • Rheumatology Physician
  • La Grande, OR
National Provider Identifier
1972690774
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
MD156467 Issued in OR
Practice address
710 Sunset Dr
La Grande, OR 97850-1200
Phone
(541) 663-3000
Fax
(541) 975-5115
NPI assigned
Oct 5, 2006
Last updated
Nov 23, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 9300627 NC
Rheumatology Physician 207RR0500X M-11620 ID
Rheumatology Physician 207RR0500X MD156467 OR Primary

Addresses

Primary practice location

710 Sunset Dr
La Grande, OR 97850-1200

Mailing address

710 Sunset Dr
La Grande, OR 97850-1200
Phone (541) 663-3000

Other names 1

  • Dr. Leslie K Wilgus Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121211000137 OR Practitioner - RheumatologyPractitioner - Internal Medicine 0042407108 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
RheumatologyAlso: Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grande Ronde Hospital IncGroup PAC ID 0547170789, 97 clinicians

Practice addresses (Care Compare)

900 Sunset Dr
La Grande, OR 97850-1362

900 Sunset Dr
La Grande, OR 97850-1387
Phone (541) 963-8421

PO Box
Suite 3290
La Grande, OR 97850

PO Box
Suite 3290
La Grande, OR 97850-7290

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-11620IDMDRheumatology Physician
9300627NCMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grande Ronde Hospital, Inc. CurrentSince Oct 1, 2020 Accepting new patients
Grande Ronde Hospital, Inc. CurrentSince Oct 1, 2020 Accepting new patients

Locations

710 Sunset Dr
La Grande, OR 97850
Phone (541) 663-3100

710 Sunset Dr
Ste F
La Grande, OR 97850
Phone (541) 663-3100

900 Sunset Dr
La Grande, OR 97850
Phone (541) 963-8421

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637625600000",
    "number": "1972690774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 SUNSET DR",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501200",
            "telephone_number": "541-663-3000",
            "fax_number": "541-975-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 SUNSET DR",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501200",
            "telephone_number": "541-663-3000",
            "fax_number": "541-975-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "LESLIE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "NC",
            "license": "9300627",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "ID",
            "license": "M-11620",
            "primary": false
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "OR",
            "license": "MD156467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESLIE",
            "last_name": "WILGUS",
            "middle_name": "K",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in La Grande, OR

Sources for this page

Verify at the official NPI Registry.