Leport Surgical Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

G47193 Issued in CA

Legal business name

LEPORT SURGICAL MEDICAL CORPORATION

Practice address

18111 Brookhurst St
Suite 5600
Fountain Valley, CA 92708-6728

Phone

(714) 861-4666

Fax

(714) 916-5534

NPI assigned

Apr 16, 2007

Organization subpart

No

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

Authorized official

Name

Peter Cary Leport, MDNPI 1932163532

Title

Provider/Owner

Phone

(714) 861-4666

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 9

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.

• Mir Baquar Ali, MD

  • Specialist
  • Fountain Valley, CA
  • NPI 1184689663
  Medicare reassignment Care Compare group NPD
• Peter Cary Leport, M.D.

  • Specialist
  • Fountain Valley, CA
  • NPI 1932163532
  Medicare reassignment NPD Authorized official
• Kais Rona

  • Surgery Physician
  • Fountain Valley, CA
  • NPI 1245650951
  Medicare reassignment Care Compare group NPD
• Michael Anthony Russo, MD

  • Surgery Physician
  • Fountain Valley, CA
  • NPI 1700084381
  Medicare reassignment Care Compare group NPD
• Ashley Junepauline Salazar, P.A.-C

  • Surgical Physician Assistant
  • Fountain Valley, CA
  • NPI 1003870114
  Medicare reassignment Care Compare group
• Philip Lou Chin, M.D.

  • Specialist
  • Fountain Valley, CA
  • NPI 1548224629
  NPD (past)
• Kelly Francis, M.D.

  • Specialist
  • Fountain Valley, CA
  • NPI 1497719504
  NPD (past)
• Asma Hussaini, PA

  • Physician Assistant
  • Thousand Oaks, CA
  • NPI 1588893838
  NPD (past)
• Grace Jin Lee, P.A.-C

  • Surgical Physician Assistant
  • Fullerton, CA
  • NPI 1912961038
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330905600000",
    "number": "1194940015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18111 BROOKHURST ST",
            "address_2": "SUITE 5600",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086728",
            "telephone_number": "714-861-4666",
            "fax_number": "714-861-4682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18111 BROOKHURST ST",
            "address_2": "SUITE 5600",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927086728",
            "telephone_number": "714-861-4666",
            "fax_number": "714-916-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEPORT SURGICAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2012-03-05",
        "status": "A",
        "authorized_official_last_name": "LEPORT",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "CARY",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "714-861-4666",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G47193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G471930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Lemont, PH.D.
• Amanda Leon, BCABA
• Monica Del Pilar Leon
• Leport
• Leport Education (LePort Medical)
• Peter Cary Leport, M.D.
• Steven Lerner, PA
• Barbara M. Lever, MD
• Carol Levi, M.D.
• David Reece Levin, DPM

• Specialist in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; 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.