Active NPI
Leroy O. Jeske, D.O.
- Family Medicine Physician
- Broken Arrow, OK
National Provider Identifier
1205839446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 1832
- Practice address
- 3100 S Elm PL Ste a
Broken Arrow, OK 74012-7950 - Phone
- (918) 455-7777
- Fax
- (918) 455-8105
- NPI assigned
- May 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1832 | OK | Primary |
Addresses
Primary practice location
3100 S Elm PL Ste a
Broken Arrow, OK 74012-7950
Mailing address
6600 S Yale Ave Ste 1400
Tulsa, OK 74136-3331
Phone (888) 247-0125
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1832 | OK | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eagle Partners, PLLC | 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 and National Provider Directory roles.
-
- Diagnostic Radiology Physician
- Duncan, OK
- NPI 1548450976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663200000000",
"number": "1205839446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6600 S YALE AVE STE 1400",
"city": "TULSA",
"state": "OK",
"postal_code": "741363331",
"telephone_number": "888-247-0125",
"fax_number": "918-502-8210"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 S ELM PL STE A",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740127950",
"telephone_number": "918-455-7777",
"fax_number": "918-455-8105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JESKE",
"first_name": "LEROY",
"middle_name": "O.",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-23",
"last_updated": "2022-09-15",
"certification_date": "2022-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OK",
"license": "1832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.