Leonard Delorenzo III, PA
Individual provider Active NPI Physician Assistant · Rutland, VT
NPI 1104851633 · NPPES record last updated Aug 22, 2013
Key facts
- NPI
- 1104851633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 055-0031054 (VT)
- Practice address
- 160 Allen St
Rutland, VT 05701-4560 - Phone
- (802) 747-1831
- Fax
- (802) 747-1826
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Duke University School of Medicine, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southwestern Vermont Medical Center, Inc
Rutland Hospital, Inc.
Practice addresses (Care Compare)
140 Hospital Dr
Bennington, VT 05201-5010
140 Hospital Dr
Bennington, VT 05201-5018
160 Allen St
Rutland, VT 05701-4560
Phone (802) 775-7111
Hospital & facility affiliations
- Southwestern Vermont Medical Center
- Rutland Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101119000131 | VT | Practitioner - Physician Assistant | 2365524766 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9101620 | FL | MD | Physician Assistant |
| 055-0031054 | VT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rutland Hospital, Inc. | Current |
Accepting new patients | |
| Rutland Hospital, Inc. | Current |
Accepting new patients | |
| Mid Vermont Pathology PC | Current | Accepting new patients | |
| Rutland Hospital, Inc. | Current | Accepting new patients | |
| Rutland Hospital, Inc | Current | Accepting new patients | |
| Southwestern Vermont Medical Center Inc. | Current |
Accepting new patients | |
| Rutland Hospital, Inc. | Current | Accepting new patients |
Locations
100 Hospital Dr
#44
Bennington, VT 05201
Phone (802) 442-4509
140 Hospital Dr
Ste 116
Bennington, VT 05201
Phone (802) 447-1836
160 Allen St
Rutland, VT 05701
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/6f43d0e7-6ff2-489b-abdc-44e8a5e0ca0a/
- leonard.delorenzo.1@3744.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9101620 | FL | |
| Physician Assistant | 363A00000X | 055-0031054 | VT | Yes |
Addresses
Primary practice location
160 Allen St
Rutland, VT 05701-4560
Mailing address
160 Allen St
Rutland, VT 05701-4560
Phone (802) 747-1831
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 291646100 | Medicaid | FL |
Other providers in Rutland, VT
- Bradley Deboer
- Sarah Decker
- James Angelo Decrisantis
- Jordan Addie Del Bianco
- Richard Delbianco
- Heather Marie Delucia
- Jon Denofer
- Tammy S Devereux
- Kevin F Devine
- Dick & Duboff Dentistry
All providers in Rutland, VT · Physician Assistant in Vermont
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.