Active NPI
Gary Merl Leverton, DDS
- Dentist
- Pontiac, IL
National Provider Identifier
1205932977
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19014346
- Practice address
- 518 West Madison St
Pontiac, IL 61764 - Phone
- (815) 844-5993
- Fax
- (815) 844-4243
- NPI assigned
- Sep 16, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 19014346 | IL | Primary |
Addresses
Primary practice location
518 West Madison St
Pontiac, IL 61764
Mailing address
1725 South Oak St
Pontiac, IL 61764
Phone (815) 844-3927
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160408000896 | IL | Order and Referring Only - Dentist | 7214235191 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19014346 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205932977",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1725 SOUTH OAK ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "61764",
"telephone_number": "815-844-3927"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "518 WEST MADISON ST",
"city": "PONTIAC",
"state": "IL",
"postal_code": "61764",
"telephone_number": "815-844-5993",
"fax_number": "815-844-4243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEVERTON",
"first_name": "GARY",
"middle_name": "MERL",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "19014346",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pontiac, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.