Individual provider Active NPI

Leslie Rumbaut, PA

  • Medical Physician Assistant
  • Grenville, SC
National Provider Identifier
1336545227
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
2233 Issued in SC
Practice address
Bon Secours Endocrinology
2 Innovation Drive, Ste 300B
Grenville, SC 29607-5261
Phone
(864) 400-3680
Fax
(864) 400-3681
NPI assigned
Nov 5, 2014
Last updated
Jun 7, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 2233 SC Primary

Addresses

Primary practice location

Bon Secours Endocrinology
2 Innovation Drive, Ste 300B
Grenville, SC 29607-5261

Mailing address

PO Box 743294
Atlanta, GA 30374-3294

Other identifiers 1

IdentifierTypeStateIssuer
2191PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150729008843 SC Practitioner - Physician Assistant 2163736562 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2 Innovation Dr
Suite 140
Greenville, SC 29607-5263
Phone (864) 295-1750

317 Saint Francis Dr
Suite 220
Greenville, SC 29601-3976
Phone (864) 255-1901

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2233SCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 21, 2022 Accepting new patients
Bon Secours Medical Group Greenville Specialty Care LLC CurrentSince May 21, 2022 Accepting new patients
Emergency Physician Services Past Accepting new patients

Locations

2 Innovation Dr
Ste 300B
Greenville, SC 29607
Phone (864) 235-7665

317 Saint Francis Dr
Ste 220
Greenville, SC 29601
Phone (864) 255-1901

Interoperability endpoints

  • Direct secure messaging: lrumbaut1155257@direct.bsmhealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1415145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528329600000",
    "number": "1336545227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 743294",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303743294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BON SECOURS ENDOCRINOLOGY",
            "address_2": "2 INNOVATION DRIVE, STE 300B",
            "city": "GRENVILLE",
            "state": "SC",
            "postal_code": "296075261",
            "telephone_number": "864-400-3680",
            "fax_number": "864-400-3681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUMBAUT",
        "first_name": "LESLIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-05",
        "last_updated": "2018-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "SC",
            "license": "2233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2191PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

Verify at the official NPI Registry.