Physician Compare National (NPI:1255453320)

HEALTHCARE PROVIDER: WOLFGANG LEESCH M.D.

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

Individual Professional Information
NPI	1255453320
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7911174016
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120112000365
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LEESCH
	Individual professional last name
Provider First Name	WOLFGANG
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	NEUROPSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	NEUROLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	NEUROLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	RIVERSIDE PHYSICIAN SERVICES INC
	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	5092608448
	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	602
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	12200 WARWICK BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 410
	Group Practice or individual's line 2 address
City	NEWPORT NEWS
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	236012548
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7575345200
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490052
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	RIVERSIDE REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	490130
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	RIVERSIDE WALTER REED HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	490037
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	RIVERSIDE SHORE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y