Individual provider Active NPI

Carrial Edward Leziton, MBBS

  • Emergency Medicine Physician
  • Pago Pago, AS
National Provider Identifier
1184070757
Registry record updated May 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2215-C Issued in AS
Practice address
96799 Turner Drive
Pago Pago, AS 96799-9994
Phone
(684) 633-1222
Fax
(684) 633-2893
NPI assigned
May 12, 2016
Last updated
May 12, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2215-C AS Primary

Addresses

Primary practice location

96799 Turner Drive
Pago Pago, AS 96799-9994

Mailing address

PO Box LBJ
Pago Pago, AS 96799-9994
Phone (684) 633-1222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AS
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

Enrollment IDStateProvider typePAC IDDetails
I20240129003345 AS Practitioner - Emergency Medicine 6608229349 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2215-CASMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
American Samoa Medical Center CurrentSince Dec 3, 2023 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": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463011200000",
    "number": "1184070757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX LBJ",
            "city": "PAGO PAGO",
            "state": "AS",
            "postal_code": "967999994",
            "telephone_number": "684-633-1222",
            "fax_number": "684-633-2893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96799 TURNER DRIVE",
            "city": "PAGO PAGO",
            "state": "AS",
            "postal_code": "967999994",
            "telephone_number": "684-633-1222",
            "fax_number": "684-633-2893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEZITON",
        "first_name": "CARRIAL",
        "middle_name": "EDWARD",
        "credential": "MBBS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-12",
        "last_updated": "2016-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AS",
            "license": "2215-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pago Pago, AS

Sources for this page

Verify at the official NPI Registry.