Gerald Clark Leake Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12008918A Issued in IN

Practice address

2828 International Cir
Suite 100
Colorado Springs, CO 80910-3127

Phone

(719) 632-5700

NPI assigned

Nov 29, 2005

Last updated

Apr 4, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Peak Vista Community Health Centers

  dba Dental

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
  • NPI 1497787535
  NPD (past)

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491264000000",
    "number": "1376527820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3205 N ACADEMY BLVD",
            "address_2": "SUITE 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809175147",
            "telephone_number": "719-632-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 INTERNATIONAL CIR",
            "address_2": "SUITE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809103127",
            "telephone_number": "719-632-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAKE",
        "first_name": "GERALD",
        "middle_name": "CLARK",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2017-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008918A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "68121725",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leah McQuigg, LLC
• Marianne B Leahy, PA-C
• Patrick J Leahy, PT
• Paul Michael Leahy, DC
• Elisa Leake
• Jessica Lealiifano, APRN
• Lean DME LLC
• Katherine Jean Leander
• Mandaryn Leander
• Leanne Deland DC LLC

• General Practice Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.