Mettisa R. K. McLeod, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036113800 Issued in IL

Practice address

501 Belt Line Rd
Suite 20-D
Collinsville, IL 62234-4410

Phone

(618) 343-6005

Fax

(618) 343-9114

NPI assigned

Aug 21, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• PC Associates, LLC

  • Family Medicine Physician
  • Dupo, IL
  • NPI 1437462637
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1235245481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DRIVE",
            "address_2": "MEMORIAL HOSPITAL CREDENTIALING DEPT",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622264061",
            "telephone_number": "618-257-4644",
            "fax_number": "618-257-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BELT LINE RD",
            "address_2": "SUITE 20-D",
            "city": "COLLINSVILLE",
            "state": "IL",
            "postal_code": "622344410",
            "telephone_number": "618-343-6005",
            "fax_number": "618-343-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLEOD",
        "first_name": "METTISA",
        "middle_name": "R. K.",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "IL",
            "license": "036113800",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036113800",
            "primary": true
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "IL",
            "license": "036113800",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "IL",
            "license": "036113800",
            "primary": false
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "IL",
            "license": "036113800",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel J McAtee, D.D.S.
• Abby McBride, LCPC
• Megan McCart, LSW
• Kristopher M McClusky, D.C.
• Patricia McDermott, LCPC
• Medexpress Urgent Care Illinois, P.C.
• Damon Meier, MPT
• Gary D Meier, OD
• Metro Dental Group LLC
• Metro East Senior Care LLC

• Family Medicine Physician in Collinsville, IL
• Providers in Collinsville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.