Individual provider Active NPI

Leandro Ernesto Hernandez Diaz, APRN

  • Family Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1376279711
Registry record updated Feb 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3018062 Issued in KY
Practice address
3015 Wilson Ave
Louisville, KY 40211-1969
Phone
(502) 774-4401
NPI assigned
Jul 27, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3018062 KY Primary

Addresses

Primary practice location

3015 Wilson Ave
Louisville, KY 40211-1969

Mailing address

3015 Wilson Ave
Louisville, KY 40211-1969
Phone (502) 774-4401

Other practice location 1

2004 Balfour Dr
Louisville, KY 40242-3459
Phone (502) 915-3872

Other identifiers 1

IdentifierTypeStateIssuer
3018086OtherKYSTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20221011001883 KY Practitioner - Nurse Practitioner 9335515634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3015 Wilson Ave
Louisville, KY 40211-1969
Phone 50277444011509

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3018062KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Park Duvalle Community Health Center, Inc. Current Accepting new patients
Park Duvalle Community Health Center, Inc CurrentSince Sep 27, 2022 Accepting new patients
Park Duvalle Community Health Center, Inc. CurrentSince Sep 27, 2022 Accepting new patients

Locations

3015 Wilson Ave
Louisville, KY 40211
Phone (502) 774-4401

3828 Bardstown Rd
Louisville, KY 40218
Phone (502) 459-4900

Interoperability endpoints

  • Direct secure messaging: leandro.hernandez.diaz.1@27238.direct.athenahealth.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1658880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676246400000",
    "number": "1376279711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 WILSON AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111969",
            "telephone_number": "502-774-4401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 WILSON AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402111969",
            "telephone_number": "502-774-4401"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2004 Balfour Dr",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402423459",
            "country_code": "US",
            "telephone_number": "502-915-3872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERNANDEZ DIAZ",
        "first_name": "LEANDRO",
        "middle_name": "ERNESTO",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-27",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3018062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "3018086",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.