Individual provider Active NPI

Leigh E Ammon, DMD

  • General Practice Dentistry
  • Pocatello, ID
National Provider Identifier
1174747190
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3998 Issued in ID
Practice address
465 Memorial Dr
Pocatello, ID 83209-8088
Phone
(208) 282-6000
Fax
(208) 282-4950
NPI assigned
Apr 12, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D3998 ID Primary
General Practice Dentistry 1223G0001X 3382-06 MS

Addresses

Primary practice location

465 Memorial Dr
Pocatello, ID 83209-8088

Mailing address

921 S 8TH Ave Stop 8088
Pocatello, ID 83209-8088
Phone (208) 282-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151111001759 OR Order and Referring Only - DentistPractitioner - Dentist 3375853971

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D3998IDMDGeneral Practice Dentistry
3382-06MSMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Idaho State University General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174747190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 S 8TH AVE STOP 8088",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832098088",
            "telephone_number": "208-282-6000",
            "fax_number": "208-282-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832098088",
            "telephone_number": "208-282-6000",
            "fax_number": "208-282-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMMON",
        "first_name": "LEIGH",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3998",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3382-06",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

Verify at the official NPI Registry.