Organization Active NPI

Leslie Havemann, MD, PLLC

  • Obstetrics & Gynecology Physician
  • Dallas, TX
National Provider Identifier
1184366080
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
LESLIE HAVEMANN, MD, PLLC
Practice address
3600 Gaston Ave Ste 651
Dallas, TX 75246-1906
Phone
(972) 304-6396
NPI assigned
Apr 11, 2022
Last updated
Apr 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

Name
Leslie Havemann, MDNPI 1679633937
Title
Owner
Phone
(972) 304-6396

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

3600 Gaston Ave Ste 651
Dallas, TX 75246-1906

Mailing address

125 Pecan Hollow Dr
Coppell, TX 75019-5319
Phone (972) 304-6396

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221018001733 TX Part B Supplier - Clinic/Group Practice 4183090087 Receives reassigned benefits from 1 practitioner
Practice locations: Grapevine, TX

National Provider Directory

National Provider Directory

Locations

1650 W College St
Rm 2202
Grapevine, TX 76051
Phone (972) 746-5939

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1184366080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 PECAN HOLLOW DR",
            "city": "COPPELL",
            "state": "TX",
            "postal_code": "750195319",
            "telephone_number": "972-304-6396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 GASTON AVE STE 651",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752461906",
            "telephone_number": "972-304-6396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LESLIE HAVEMANN, MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "HAVEMANN",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-304-6396",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.