Active NPI
Leslie Shane Gilliam, MD
- Family Medicine Physician
- Stephenville, TX
National Provider Identifier
1073580916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- L7278
- Practice address
- 205 E Frey St Ste 201
Stephenville, TX 76401-2600 - Phone
- (254) 965-2313
- Fax
- (254) 965-2363
- NPI assigned
- Feb 28, 2006
- Last updated
- Dec 9, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | L7278 | TX | Primary |
Addresses
Primary practice location
205 E Frey St Ste 201
Stephenville, TX 76401-2600
Mailing address
205 E Frey St Ste 201
Stephenville, TX 76401-2600
Phone (254) 965-2313
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 22, 2014 through Jan 22, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L7278 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deuteronomy | Past | Accepting new patients | |
| McLennan County Medical Education and Research Foundation | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EJAEDD/Endpoint/EJAEDD
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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- Waco, TX
- NPI 1689651440
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481241600000",
"number": "1073580916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "205 E FREY ST STE 201",
"city": "STEPHENVILLE",
"state": "TX",
"postal_code": "764012600",
"telephone_number": "254-965-2313",
"fax_number": "254-965-2363"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 E FREY ST STE 201",
"city": "STEPHENVILLE",
"state": "TX",
"postal_code": "764012600",
"telephone_number": "254-965-2313",
"fax_number": "254-965-2363"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIAM",
"first_name": "LESLIE",
"middle_name": "SHANE",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-28",
"last_updated": "2016-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "TX",
"license": "L7278",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stephenville, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.