Active NPI
Randolfo De Leon, M.D.
- Surgery Physician
- Independence, IA
National Provider Identifier
1356483663
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 20387
- Practice address
- 1600 1St St E
Independence, IA 50644-3155 - Phone
- (319) 334-6071
- Fax
- (319) 334-6149
- NPI assigned
- Feb 13, 2007
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 20387 | IA | Primary |
Addresses
Primary practice location
1600 1St St E
Independence, IA 50644-3155
Mailing address
2195 Double L Dr
Independence, IA 50644-9658
Phone (319) 334-2310
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20387 | IA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Penobscot Valley Hospital | Past | Accepting new patients | |
| Hospital & Medical Foundation of Paris, Inc. | Surgery | Past | Accepting new patients |
Interoperability endpoints
- https://api.platform.athenahealth.com/5664/brand/1/csg/1/fhir/r4
- https://fhir-usa.unify.chbase.com/org/penob-eadbba22
Organizations & group practices 2
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.
-
dba Horizon Health
- Clinic/Center
- Paris, IL
- NPI 1629280367
Surgery
-
- Critical Access Hospital
- Lincoln, ME
- NPI 1093716086
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": "1183852800000",
"number": "1356483663",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2195 DOUBLE L DR",
"city": "INDEPENDENCE",
"state": "IA",
"postal_code": "506449658",
"telephone_number": "319-334-2310"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 1ST ST E",
"city": "INDEPENDENCE",
"state": "IA",
"postal_code": "506443155",
"telephone_number": "319-334-6071",
"fax_number": "319-334-6149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LEON",
"first_name": "RANDOLFO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IA",
"license": "20387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Independence, IA
- Muhammad Afzal Chowdhry, MD
- Cornerstone Family Therapy, LLC
- Counseling and Assessment Service, PC
- County of Buchanan (Buchanan County Ambulance Service)
- Bhasker Jethalal Dave, MD
- Kimberly Deterding, LAC; LMT
- Sarah Rae Devore, ARNP
- Connie R Divis, RPH
- Dr Mark M Zimmer PC (Belle Plaine Family Eyecare)
- Dr. Mark M. Zimmer P.C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.