Ryan Gaston Leckner

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

22655 Indianwood Dr
South Lyon, MI 48178-9420

Phone

(248) 880-0878

NPI assigned

Sep 9, 2024

Last updated

Sep 9, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pain Specialists of CharlestonGroup PAC ID 6002971165, 17 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Pain Specialists of Charleston PA

  • Interventional Pain Medicine Physician
  • North Charleston, SC
  • NPI 1760636856
  Medicare reassignment Care Compare group NPD
• Pain Specialists of Charleston

  dba Pain & Neurology Specialists of Pawley's Island

  • Interventional Pain Medicine Physician
  • Pawley's Island, SC
  • NPI 1376218404
  NPD

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

{
    "created_epoch": "1725840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1154157907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22655 INDIANWOOD DR",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481789420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22655 INDIANWOOD DR",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481789420",
            "telephone_number": "248-880-0878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LECKNER",
        "first_name": "RYAN",
        "middle_name": "GASTON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-09",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Lantto
• Marie Christine Larose, LMSW, CAADC
• Kristen Leigh Latra, MA, CCC-SLP
• Jeffrey Lau, D.O.
• Leah Towers Speech and Language, LLC
• Ellen Thomi Lecureux, PHYSICAL THERAPIST
• Michaela Rose Lee
• Lauren Leija, MA, CCC-SLP
• Ariel Levy, D.D.S.
• Hannah Liabenow

• Physician Assistant in South Lyon, MI
• Providers in South Lyon, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.