NPIMap

Individual provider Active NPI

Eric B Leach, PA-C

  • Physician Assistant
  • Provo, UT
National Provider Identifier
1124068739
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2533 Issued in AZ
Practice address
1055 N 500 W
Suite 121
Provo, UT 84604-3305
Phone
(801) 373-7350
NPI assigned
Jun 8, 2006
Last updated
Nov 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2533 AZ Primary
Surgical Physician Assistant 363AS0400X 8533 AZ

Addresses

Primary practice location

1055 N 500 W
Suite 121
Provo, UT 84604-3305

Mailing address

1055 N 500 W
Credentialing Department
Provo, UT 84604-3305
Phone (800) 135-4822

Other identifiers 1

IdentifierTypeStateIssuer
867525MedicaidAZ

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eleach306712@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090218000088 UT Practitioner - Physician Assistant 3375433709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

50 N Medical Dr
Salt Lake City, UT 84132-0100
Phone (801) 587-6336

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.61 of 100Reported as group
Quality
93.24
Promoting interoperability
100
Improvement activities
40
Cost
45.48

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Specialty Services CurrentSince Oct 10, 2018 Accepting new patients
University of Utah Specialty Services CurrentSince Oct 10, 2018 Accepting new patients
Glendale Urgent Care LLC Past Accepting new patients
Nextcare Arizona I JV LLC Past Accepting new patients
Shea Urgent Care LLC Past Accepting new patients
Avondale Urgent Care LLC Past Accepting new patients
Pinnacle Medicine Inc. Past Accepting new patients
Greenway Urgent Care LLC Past Accepting new patients
Dana Landing Urgent Care LLC Past Accepting new patients
University of Utah Specialty Services Past Accepting new patients
Revere Health PC Past Accepting new patients
Desert Ridge Urgent Care LLC Past Accepting new patients
Chandler Urgent Care LLC Past Accepting new patients
Southwest Center for Neurological Surgeons PC Past Accepting new patients
Desert Neurosurgery, PC Past Accepting new patients
Sun City Urgent Care LLC Past Accepting new patients

Locations

250 E 200 S
Ste 1350
Salt Lake City, UT 84111
Phone 80158763362003

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1124068739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "CREDENTIALING DEPARTMENT",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "800-135-4822",
            "fax_number": "801-429-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "SUITE 121",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-373-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEACH",
        "first_name": "ERIC",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2533",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "8533",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "867525",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eleach306712@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Provo, UT

Sources for this page

Verify at the official NPI Registry.