Active NPI
Leawood P Emmerton, PA C
- Physician Assistant
- Worcester, MA
National Provider Identifier
1407835333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 60
- Practice address
- 123 Summer St
Worcester, MA 01608-1216 - Phone
- (508) 368-3130
- Fax
- (508) 368-3167
- NPI assigned
- Jan 10, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 60 | MA | Primary |
Addresses
Primary practice location
123 Summer St
Worcester, MA 01608-1216
Mailing address
630 Plantation St
Worcester, MA 01605
Phone (508) 368-3130
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60 | MA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reliant Medical Group, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Worcester, MA
- NPI 1295827962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1407835333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 PLANTATION ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01605",
"telephone_number": "508-368-3130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 SUMMER ST",
"city": "WORCESTER",
"state": "MA",
"postal_code": "016081216",
"telephone_number": "508-368-3130",
"fax_number": "508-368-3167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EMMERTON",
"first_name": "LEAWOOD",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "60",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.