Physician Compare National (NPI:1093827685)

HEALTHCARE PROVIDER: KEVIN ALAN LEISEBERG MS, PT

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1093827685
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1658386552
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20060214000510
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LEISEBERG
	Individual professional last name
Provider First Name	KEVIN
	Individual professional first name
Provider Middle Name	ALAN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	PT
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1997
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	MERCY HEALTH SYSTEM CORPORATION
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	7416860440
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	435
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	348 S DIVISION ST
	Group Practice or individual's line 1 address
Line 2 Street Address	HARVARD CLINIC SOUTH
	Group Practice or individual's line 2 address
City	HARVARD
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	600333247
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8159431122
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y