Bryce D Leavitt, DMD, MD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

SZ-127 Issued in NV

Practice address

670 S Green Valley Pkwy #15
Henderson, NV 89052

Phone

(702) 685-3700

Fax

(702) 685-3701

NPI assigned

Jun 11, 2007

Last updated

Mar 19, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Maxillofacial Surgery

Education

Oregon Health & Sciences Univ School of Dentistry, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gibson and Leavitt Oral Maxillofacial and Implant SurgeryGroup PAC ID 0749595205, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Gibson & Leavitt Oral, Maxillofacial and Implant Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Henderson, NV
  • NPI 1871820530
  Medicare reassignment Care Compare group NPD
• Dignity Health

  dba St. Rose Dominican Hospital, Rose de Lima Campus

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1447393152
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181520000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1093919417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 S GREEN VALLEY PKWY #15",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89052",
            "telephone_number": "702-685-3700",
            "fax_number": "702-685-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 S GREEN VALLEY PKWY #15",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "89052",
            "telephone_number": "702-685-3700",
            "fax_number": "702-685-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAVITT",
        "first_name": "BRYCE",
        "middle_name": "D",
        "credential": "DMD, MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-11",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NV",
            "license": "SZ-127",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NV",
            "license": "6227",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "D12476",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "MN",
            "license": "55354",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33826800",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ENROLLED",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "884127000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candance Leaphart-St Cloud, D.O.
• Leavitt Acupuncture PLLC
• Leavitt Medical Associates of Nevada PC
• Leavitt Physical Therapy, PLLC
• Autumn Leavitt, OMD
• Jeffrey Paul Leavitt, PT, DPT
• Tracy Kyle Leavitt, DPM
• Diana Leblanc, MD
• Julie Anne Leblanc, MS, OTR/L
• Diann Lebsack

• Oral and Maxillofacial Surgery (Dentist) in Henderson, NV
• Providers in Henderson, NV by specialty
• Oral and Maxillofacial Surgery (Dentist) in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.