DR. MATTHEW LIESEN DMD
NPI 1619350725
Dentist - General Practice in Peoria, IL

Q: What is Matthew Liesen's NPI number?

The NPI number for Matthew Liesen is 1619350725. It was assigned to this individual provider in the NPPES registry on July 7, 2015.

Q: What is Matthew Liesen's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Matthew Liesen was last updated on July 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 07, 2015PECOS Enrolled

4517 N ROCKWOOD DR, PEORIA, IL 61615(309) 688-0121(309) 688-5643 Get Directions Write a Review

NPPES record last updated: July 7, 2021. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jul 7, 2021, Dec 10, 2020, Oct 6, 2020 (3 updates tracked since 2020).

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About Dr. Matthew Liesen Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. MATTHEW LIESEN DMD (NPI 1619350725) is an individual general practice provider in Peoria, Illinois, licensed in Illinois (019030226) and active in the NPI registry since July 2015. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619350725

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. MATTHEW LIESENCredential: DMD

Location Address4517 N ROCKWOOD DRPeoria, IL 61615-3841

Mailing Address4517 N Rockwood DrPeoria, IL 61615-3841 · (309) 688-0121 · Fax (096) 885-6433

Phone(309) 688-0121

Fax(309) 688-5643

Sole ProprietorNo

Enumeration DateJuly 7, 2015

Last NPPES UpdateJuly 7, 20213 updates tracked since enumeration

NPPES CertifiedJuly 7, 2021

✔ NPI 1619350725 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in IL · 019030226

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Also ListedDentist · Dental Public HealthTaxonomy 1223D0001X · License 019.030226 (IL)

4517 N ROCKWOOD DR, Peoria, IL 61615

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Other Identifiers 1

Other1851909345IL · Peoria Dental Care, Llc.

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Matthew Liesen Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 61615 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$68.64 typical visit price

range $17.16 – $136.56

Typical copayment $17.16 (range $4.29 – $34.14)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ROBERT M. WYNN DMD

Dentist (General Practice)