NPIMap

Individual provider Active NPI

Leonard Mark Wilk, MD

  • Family Medicine Physician
  • White City, OR
National Provider Identifier
1326180688
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD29044 Issued in OR
Practice address
2841 Avenue G Suite
Suite 100
White City, OR 97503-3030
Phone
(541) 826-5252
Fax
(541) 789-5785
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD29044 OR Primary

Addresses

Primary practice location

2841 Avenue G Suite
Suite 100
White City, OR 97503-3030

Mailing address

2825 E Barnett Rd
MSS
Medford, OR 97504-8332
Phone (541) 789-4281

Other identifiers 1

IdentifierTypeStateIssuer
500605321MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20090707000738 OR Practitioner - Family PracticePractitioner - Geriatric Medicine 2365534054 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Asante Physician PartnersGroup PAC ID 8325206246, 227 clinicians

Practice addresses (Care Compare)

2841 Ave G
Suite 100
White City, OR 97503-3030
Phone (541) 826-5252

Hospital & facility affiliations

  • Accentcare Home Health of Rogue Valley, LLC Home health agency, Medford, OR, CCN 387098
  • Riverside Home Health Care Home health agency, Grants Pass, OR, CCN 387143
  • Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
  • Asante Ashland Community Hospital Hospital, Ashland, OR, CCN 380005
  • Providence Medford Medical Center Hospital, Medford, OR, CCN 380075
  • Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Asante Physician Partners Family Medicine CurrentSince Oct 2, 2017 Accepting new patients

Locations

625 SW Ramsey Ave
Ste A
Grants Pass, OR 97527
Phone (541) 474-5004

2825 E Barnett Rd
Medford, OR 97504
Phone (541) 282-6770

2841 Avenue G
Ste 100
White City, OR 97503
Phone (541) 826-5252

Organizations & group practices 1

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.

Hospital & facility affiliations 6

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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680566400000",
    "number": "1326180688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 E BARNETT RD",
            "address_2": "MSS",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048332",
            "telephone_number": "541-789-4281",
            "fax_number": "541-789-4806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2841 AVENUE G SUITE",
            "address_2": "SUITE 100",
            "city": "WHITE CITY",
            "state": "OR",
            "postal_code": "975033030",
            "telephone_number": "541-826-5252",
            "fax_number": "541-789-5785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILK",
        "first_name": "LEONARD",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD29044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500605321",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White City, OR

Sources for this page

Verify at the official NPI Registry.