Active NPI
Johnette K Leikam, MD
- Pediatrics Physician
- Livermore, CA
National Provider Identifier
1407805484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- C41599
- Practice address
- 1133 E Stanley Blvd
#103
Livermore, CA 94550-4200 - Phone
- (925) 455-5050
- Fax
- (925) 667-2122
- NPI assigned
- May 8, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C41599 | CA | Primary |
Addresses
Primary practice location
1133 E Stanley Blvd
#103
Livermore, CA 94550-4200
Mailing address
1133 E Stanley Blvd
#103
Livermore, CA 94550-4200
Phone (925) 455-5050
Other names 1
- Johnette Leikam Peterson
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 |
|---|---|---|---|
| C41599 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LPCH Medical Group Div of Lucile | Pediatrics | Past | Accepting new patients |
| Bruce M. Gach, M.D., Inc. | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Specialist
- Livermore, CA
- NPI 1801897806
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479081600000",
"number": "1407805484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1133 E STANLEY BLVD",
"address_2": "#103",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945504200",
"telephone_number": "925-455-5050",
"fax_number": "925-667-2122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 E STANLEY BLVD",
"address_2": "#103",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945504200",
"telephone_number": "925-455-5050",
"fax_number": "925-667-2122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEIKAM",
"first_name": "JOHNETTE",
"middle_name": "K",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-08",
"last_updated": "2016-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "C41599",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JOHNETTE",
"last_name": "PETERSON",
"middle_name": "LEIKAM",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Livermore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.