Mervin Nigel Leader, M.D.
Individual provider Active NPI Psychiatry Physician · Fairfield, IL
NPI 1255522611 · NPPES record last updated Feb 10, 2025
Key facts
- NPI
- 1255522611
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 036163562 (IL)
- Practice address
- 844 County Road 2150 E
Fairfield, IL 62837-2823 - Phone
- (479) 259-8855
- Fax
- (870) 364-9774
- NPI assigned
- Aug 9, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20071026000338 | AR | Practitioner - Psychiatry | 8729175583 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036163562 | IL | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Francis House Nwa, Inc | Current |
Accepting new patients | |
| St Francis House Nwa, Inc | Current |
Accepting new patients | |
| St Francis House Nwa, Inc | Current | Accepting new patients | |
| St. Francis House Nwa, Inc. | Current |
Accepting new patients | |
| Volunteers of America of Indiana, Inc | Current |
Accepting new patients | |
| Perspectives Behavioral Health Management, LLC | Past |
Accepting new patients |
Locations
3729 N Crossover Rd
Ste 107
Fayetteville, AR 72703
Phone (479) 443-7791
500 S Mount Olive St
Siloam Springs, AR 72761
Phone (479) 524-3606
610 E Emma Ave
Ste C
Springdale, AR 72764
614 E Emma Ave
Ste 300
Springdale, AR 72764
Phone (479) 751-4898
927 N Pennsylvania St
Indianapolis, IN 46204
Phone (317) 686-5800
Interoperability endpoints
- mleader.p4@direct.horizonhealthcare.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | E-5515 | AR | |
| Psychiatry Physician | 2084P0800X | 036163562 | IL | Yes |
Addresses
Primary practice location
844 County Road 2150 E
Fairfield, IL 62837-2823
Mailing address
303 NW 11TH St
Fairfield, IL 62837-1203
Phone (618) 842-4617
Other providers in Fairfield, IL
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- Bradley D Kramer
- Dewain L Kramer
- Lab One LLC
- Marla K Lafikes
- Brenda S. Lefever
- David M Link
- Little Egypt Surgical Assisting L.L.C
- McKenna D Loss
- Melanie S. Maas
All providers in Fairfield, IL · Psychiatry Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.