Individual provider Active NPI

John William Leroux, PA

  • Physician Assistant
  • Midland, MI
National Provider Identifier
1063746949
Registry record updated Nov 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003000 Issued in MI
Practice address
4201 Campus Ridge Drive
Midland, MI 48640
Phone
(989) 839-1795
Fax
(989) 839-1785
NPI assigned
Sep 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601003000 MI Primary

Addresses

Primary practice location

4201 Campus Ridge Drive
Midland, MI 48640

Mailing address

4201 Campus Ridge Drive
Midland, MI 48640
Phone (989) 839-1795

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120920000224 MI Practitioner - Physician Assistant 4880842665 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians

Practice addresses (Care Compare)

4000 Wellness Dr
Midland, MI 48670-2000
Phone (989) 633-8018

4500 Campus Ridge Dr
Midland, MI 48640-6123
Phone (989) 837-9250

Hospital & facility affiliations

  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601003000MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Group CurrentSince Sep 4, 2012 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 1, 2015 Accepting new patients
Mymichigan Medical Center Alpena CurrentSince Sep 4, 2012 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 1, 2015 Accepting new patients

Locations

602 Beech St
Ste 3100
Clare, MI 48617
Phone (989) 802-5020

609 Quarter St
Gladwin, MI 48624
Phone (989) 246-6371

4201 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 488-5450

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

4100 Campus Ridge Dr
Midland, MI 48640
Phone (989) 488-5450

Organizations & group practices 5

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

Hospital & facility affiliations 3

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": "1253836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478131200000",
    "number": "1063746949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 CAMPUS RIDGE DRIVE",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-839-1795",
            "fax_number": "989-839-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 CAMPUS RIDGE DRIVE",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48640",
            "telephone_number": "989-839-1795",
            "fax_number": "989-839-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEROUX",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-09-25",
        "last_updated": "2016-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.