Individual provider Active NPI

Leonard Joel Spillert, M.D.

  • General Practice Physician
  • Jacksonville, FL
National Provider Identifier
1326007139
Registry record updated Sep 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ME17473 Issued in FL
Practice address
4217 Baymeadows Rd
Suite 3
Jacksonville, FL 32217-4676
Phone
(904) 332-7431
Fax
(904) 332-7408
NPI assigned
Mar 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X ME17473 FL Primary

Addresses

Primary practice location

4217 Baymeadows Rd
Suite 3
Jacksonville, FL 32217-4676

Mailing address

4217 Baymeadows Rd
Suite 3
Jacksonville, FL 32217-4676
Phone (904) 332-7431

Other identifiers 1

IdentifierTypeStateIssuer
71614OtherFLBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060412000237 FL Practitioner - General PracticePractitioner - Plastic and Reconstructive Surgery 2264449321 Practice locations: St Augustine, FL; Jacksonville Beach, FL; Jacksonville, FL

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: leonard.spillert.1@16002.direct.athenahealth.com

NPI Registry JSON

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

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1326007139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4217 BAYMEADOWS RD",
            "address_2": "SUITE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174676",
            "telephone_number": "904-332-7431",
            "fax_number": "904-332-7408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4217 BAYMEADOWS RD",
            "address_2": "SUITE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174676",
            "telephone_number": "904-332-7431",
            "fax_number": "904-332-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPILLERT",
        "first_name": "LEONARD",
        "middle_name": "JOEL",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-21",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME17473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "71614",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.