Active NPI
Wayne Frederick Leebaw, MD
- Specialist
- Edina, MN
National Provider Identifier
1033178405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 23267
- Practice address
- 7701 York Ave S
Suite 180
Edina, MN 55435-5845 - Phone
- (952) 927-7810
- Fax
- (952) 927-6309
- NPI assigned
- Mar 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 23267 | MN | Primary |
Addresses
Primary practice location
7701 York Ave S
Suite 180
Edina, MN 55435-5845
Mailing address
7701 York Ave S
Suite 180
Edina, MN 55435-5845
Phone (952) 927-7810
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120263C626 | Other | MN | UCARE |
| 21002 | Other | MN | AMERICA'S PPO |
| 3317283 | Other | MN | MEDICA CHOICE |
| 410999025 | Other | MN | TRICARE |
| 656388100 | Medicaid | MN | |
| 0256006 | Other | MN | SELECT CARE |
| 3300003 | Other | MN | MEDICA PRIMARY |
| HP13803 | Other | MN | HEALTH PARTNERS |
| 53967LE | Other | MN | BLUE CROSS BLUE SHIELD |
| 960540799004 | Other | MN | PREFERRED ONE |
| 104082 | Other | MN | PATIENT CHOICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23267 | MN | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210032000000",
"number": "1033178405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7701 YORK AVE S",
"address_2": "SUITE 180",
"city": "EDINA",
"state": "MN",
"postal_code": "554355845",
"telephone_number": "952-927-7810",
"fax_number": "952-927-6309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7701 YORK AVE S",
"address_2": "SUITE 180",
"city": "EDINA",
"state": "MN",
"postal_code": "554355845",
"telephone_number": "952-927-7810",
"fax_number": "952-927-6309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEEBAW",
"first_name": "WAYNE",
"middle_name": "FREDERICK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-22",
"last_updated": "2008-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MN",
"license": "23267",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "120263C626",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "21002",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA CHOICE",
"identifier": "3317283",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "410999025",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "656388100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SELECT CARE",
"identifier": "0256006",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA PRIMARY",
"identifier": "3300003",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "HP13803",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "53967LE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "960540799004",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PATIENT CHOICE",
"identifier": "104082",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.