Leonard Simon Fagan, M.D.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

ME157114 Issued in FL

Practice address

10222 74TH Street
Suite 200
Kenosha, WI 53142-6800

Phone

(262) 697-9200

Fax

(262) 697-9206

NPI assigned

Sep 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in FL

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

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.

• OB Hospitalist Group LLC

  • Obstetrics & Gynecology Physician
  • Boca Raton, FL
  • NPI 1710647334
  Medicare reassignment NPD
• OB Hospitalist Group LLC

  • Obstetrics & Gynecology Physician
  • Winter Haven, FL
  • NPI 1851282016
  NPD
• Midwest Center for Women's Health

  • Specialist
  • Kenosha, WI
  • NPI 1194903518
  NPD (past)

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

{
    "created_epoch": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1104812171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 W FOREST HOME AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532152843",
            "telephone_number": "414-389-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10222 74TH STREET",
            "address_2": "SUITE 200",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531426800",
            "telephone_number": "262-697-9200",
            "fax_number": "262-697-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "LEONARD",
        "middle_name": "SIMON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WI",
            "license": "46372-020",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "46372",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "FL",
            "license": "ME157114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34485700",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "10222 74th Street",
            "address_2": "Suite 200",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531426800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lfagan244443@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10222 74th Street",
            "address_2": "Suite 200",
            "city": "Kenosha",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531426800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ew Counseling, Inc.
• Extendicare Homes, Inc. (Hospitality Nursing & Rehabilitation Center)
• Eye Care 4 U, S.C.
• Eye Xamz
• Andrea K-P Fafford, LCSW
• Dennis John Fahey, D.D.S.
• Emily Ann Fair, RBT
• Kathleen Kay Falk, COTA
• Familia Dental Kenosha LLC
• Family Care Chiropractic Center, Inc.

• Obstetrics & Gynecology Physician in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Obstetrics & Gynecology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.