NPIMap

Individual provider Active NPI

Leon C Sidorek, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Tunkhannock, PA
National Provider Identifier
1336145085
Registry record updated Nov 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
SC-002903-L Issued in PA
Practice address
12 Grace Dr
Suite 2
Tunkhannock, PA 18657-9120
Phone
(570) 836-3668
Fax
(570) 836-5710
NPI assigned
Jun 27, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X SC-002903-L PA Primary

Addresses

Primary practice location

12 Grace Dr
Suite 2
Tunkhannock, PA 18657-9120

Mailing address

12 Grace Dr
Ste 2
Tunkhannock, PA 18657-9120
Phone (570) 836-3668

Other identifiers 1

IdentifierTypeStateIssuer
0010088450003MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100423000114 PA Practitioner - Podiatry 6709913718 Practice locations: Tunkhannock, PA
O20100930087021 PA DME Supplier - Physician - Podiatry 8123233509 Practice locations: Tunkhannock, PA

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12 Grace Dr
Tunkhannock, PA 18657-9120
Phone (570) 836-3668

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue34
Removal of skin lesions31
Removal of nail tissue2269
Removal or shaving of skin growth867

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SC-002903-LPAMDFoot & Ankle Surgery Podiatrist

Hospital & facility affiliations 32

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258588800000",
    "number": "1336145085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 GRACE DR",
            "address_2": "STE 2",
            "city": "TUNKHANNOCK",
            "state": "PA",
            "postal_code": "186579120",
            "telephone_number": "570-836-3668",
            "fax_number": "570-836-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 GRACE DR",
            "address_2": "SUITE 2",
            "city": "TUNKHANNOCK",
            "state": "PA",
            "postal_code": "186579120",
            "telephone_number": "570-836-3668",
            "fax_number": "570-836-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDOREK",
        "first_name": "LEON",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2009-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "PA",
            "license": "SC-002903-L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0010088450003",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tunkhannock, PA

Sources for this page

Verify at the official NPI Registry.