Individual provider Active NPI

Rhonda Leigh Leake, PA-C

  • Physician Assistant
  • Lawrenceville, GA
National Provider Identifier
1245443043
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3904 Issued in GA
Practice address
1000 Medical Center Blvd
Lawrenceville, GA 30045-7694
Phone
(678) 442-3317
NPI assigned
May 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3904 GA Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Lawrenceville, GA 30045-7694

Mailing address

950 W Peachtree St NW
Unit 409
Atlanta, GA 30309-3846
Phone (678) 637-3567

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070724000391 GA Practitioner - Physician Assistant 1355442161 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gwinnett Emergency Specialists Observation Services LLCGroup PAC ID 7618140955, 38 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (954) 939-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3904GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northside Hospital, Inc. CurrentSince Sep 26, 2002 Accepting new patients
Northside Emergency Associates, LLC Physician Assistant CurrentSince May 1, 2008 Accepting new patients

Locations

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245443043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 W PEACHTREE ST NW",
            "address_2": "UNIT 409",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303093846",
            "telephone_number": "678-637-3567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300457694",
            "telephone_number": "678-442-3317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAKE",
        "first_name": "RHONDA",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "3904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.