Individual provider Active NPI

Alixandra Bianca Leestma

  • Registered Dietitian
  • Tacoma, WA
National Provider Identifier
1104489954
Registry record updated Apr 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DI60943877 Issued in WA
Practice address
2202 S Cedar St Ste 300
Tacoma, WA 98405-2318
Phone
(253) 301-5280
NPI assigned
Apr 17, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X DI60943877 WA Primary

Addresses

Primary practice location

2202 S Cedar St Ste 300
Tacoma, WA 98405-2318

Mailing address

PO Box 5299
Ms: 737-3-Pcon
Tacoma, WA 98415-0299

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190619001529 WA Practitioner - Registered Dietitian Or Nutrition Professional 0648504001 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

4545 Point Fosdick Dr
Gig Harbor, WA 98335-1700
Phone (253) 530-8011

4700 Point Fosdick Dr
Gig Harbor, WA 98335-1706

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Apr 29, 2019 Accepting new patients
Multicare Health System CurrentSince Apr 29, 2019 Accepting new patients
Multicare Health System Current Accepting new patients
Multicare Health System Dietitian, Registered Past Accepting new patients
Fay Nutrition Dietitian, Registered Past Accepting new patients

Locations

4545 Point Fosdick Dr
Ste 250
Gig Harbor, WA 98335
Phone (253) 267-5755

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

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.

NPI Registry JSON

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

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1104489954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5299",
            "address_2": "MS: 737-3-PCON",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984150299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2202 S CEDAR ST STE 300",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984052318",
            "telephone_number": "253-301-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEESTMA",
        "first_name": "ALIXANDRA",
        "middle_name": "BIANCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "WA",
            "license": "DI60943877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.