Active NPI
Lee Barry Leavelle, PA
- Physician Assistant
- Mount Vernon, NY
National Provider Identifier
1316006588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0003531
- Practice address
- 107 W 4TH Street
Mount Vernon Neighborhood Health Ctr
Mount Vernon, NY 10550 - Phone
- (914) 699-7200
- Fax
- (914) 699-0837
- NPI assigned
- Dec 6, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0003531 | NY | Primary |
Addresses
Primary practice location
107 W 4TH Street
Mount Vernon Neighborhood Health Ctr
Mount Vernon, NY 10550
Mailing address
107 West 4TH Street
Mount Vernon Neighborhood Health Center
Mount Vernon, NY 10550
Phone (914) 699-7200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0003531 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383609600000",
"number": "1316006588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 WEST 4TH STREET",
"address_2": "MOUNT VERNON NEIGHBORHOOD HEALTH CENTER",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "10550",
"telephone_number": "914-699-7200",
"fax_number": "914-699-0837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 W 4TH STREET",
"address_2": "MOUNT VERNON NEIGHBORHOOD HEALTH CTR",
"city": "MOUNT VERNON",
"state": "NY",
"postal_code": "10550",
"telephone_number": "914-699-7200",
"fax_number": "914-699-0837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEAVELLE",
"first_name": "LEE",
"middle_name": "BARRY",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-06",
"last_updated": "2013-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "0003531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Vernon, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.