NPIMap

Individual provider Active NPI

Jeffrey Paul Leclair, PSY.D., PA-C

  • Physician Assistant
  • Mt. Vernon, MO
National Provider Identifier
1295044303
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2011002799 Issued in MO
Practice address
1011 South East Street
Mt. Vernon, MO 65712
Phone
(417) 466-7191
Fax
(417) 466-3876
NPI assigned
Oct 7, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

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 2011002799 MO Primary

Addresses

Primary practice location

1011 South East Street
Mt. Vernon, MO 65712

Mailing address

1011 S East St
Mount Vernon, MO 65712-1331
Phone (417) 466-7191

Other practice location 1

108 S Hickory St
Mount Vernon, MO 65712-1407
Phone (417) 466-4110

Other practice location 2

1540 E Evergreen St
Springfield, MO 65803-4300
Phone (417) 823-2900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140109001766 MO Practitioner - Physician Assistant 9830327238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sgoh Acquisition IncGroup PAC ID 5092616276, 95 clinicians

Practice addresses (Care Compare)

106 S Hickory St
Mount Vernon, MO 65712-1407
Phone (417) 466-4110

108 S Hickory St
Mount Vernon, MO 65712-1407
Phone (417) 466-4110

1540 E Evergreen St
Springfield, MO 65803-4300
Phone (417) 823-2900

Hospital & facility affiliations

  • Ozarks Community Hospital of Gravette Hospital, Gravette, AR, CCN 041331

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Primrose Nephrology, Inc. Current Accepting new patients
Sgoh Acquisition Inc CurrentSince Jul 13, 2025 Accepting new patients
Sgoh Acquisition Inc CurrentSince Jul 13, 2025 Accepting new patients
Cheryl G Williams DO PC PastSince Jul 1, 2002 Accepting new patients

Locations

1101 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221

106 S Hickory St
Mount Vernon, MO 65712
Phone (417) 466-4110

108 S Hickory St
Mount Vernon, MO 65712
Phone (417) 466-4110

1540 E Evergreen St
Springfield, MO 65803
Phone (417) 823-2900

Organizations & group practices 18

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.

View all 18

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": "1286409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1295044303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 S EAST ST",
            "city": "MOUNT VERNON",
            "state": "MO",
            "postal_code": "657121331",
            "telephone_number": "417-466-7191",
            "fax_number": "417-466-3876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 SOUTH EAST STREET",
            "city": "MT. VERNON",
            "state": "MO",
            "postal_code": "65712",
            "telephone_number": "417-466-7191",
            "fax_number": "417-466-3876"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "108 S Hickory St",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "MO",
            "postal_code": "657121407",
            "country_code": "US",
            "telephone_number": "417-466-4110",
            "fax_number": "417-466-4255",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1540 E Evergreen St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MO",
            "postal_code": "658034300",
            "country_code": "US",
            "telephone_number": "417-823-2900",
            "fax_number": "417-823-2980",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LECLAIR",
        "first_name": "JEFFREY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "PSY.D., PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-07",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2011002799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt. Vernon, MO

Sources for this page

Verify at the official NPI Registry.