Leon Martin Bard, P.A.C.
Individual provider Active NPI Physician Assistant · Summerfield, FL
NPI 1255769758 · NPPES record last updated Oct 18, 2013
Key facts
- NPI
- 1255769758
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA9107447 (FL)
- Practice address
- 17820 SE 109TH Ave Ste 108
Summerfield, FL 34491-8968 - Phone
- (352) 693-2340
- NPI assigned
- Oct 18, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160426001252 | FL | Practitioner - Physician Assistant | 9436458452 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9107447 | FL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orlando Health Medical Group Inc | Current |
Accepting new patients | |
| Orlando Health, Inc. | Current | Accepting new patients |
Locations
511 Medical Plaza Dr
Ste 101
Leesburg, FL 34748
32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820
Interoperability endpoints
- lbard347327@orlandohealth.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9107447 | FL | Yes |
Addresses
Primary practice location
17820 SE 109TH Ave Ste 108
Summerfield, FL 34491-8968
Mailing address
17820 SE 109TH Ave Ste 108
Summerfield, FL 34491-8968
Phone (352) 693-2340
Other providers in Summerfield, FL
- Avecina Medical, PA
- Eniola Ayoola
- Carla Renee Bailey
- Catherine Baitinger
- Mary F Barber
- Kenneth P Barnes
- Orlando Batista Fernandez
- Baylee Dental PA
- Be a Success Enterprises LLC
- Beach Cities Psychological Clinic, Inc.
All providers in Summerfield, FL · Physician Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2013. 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.