Jack Deleonardo, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

196 Issued in MT

Practice address

650 E Indian School Rd
Dept Veterans Affairs
Phoenix, AZ 85012

Phone

(602) 277-5551

NPI assigned

Aug 31, 2006

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 3

Medicare fee-for-service enrollment

Enrolled in AZ

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478044800000",
    "number": "1417068248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2699 S 167TH DR",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853387317",
            "telephone_number": "406-927-2221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 E INDIAN SCHOOL RD",
            "address_2": "DEPT VETERANS AFFAIRS",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85012",
            "telephone_number": "602-277-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELEONARDO",
        "first_name": "JACK",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDCD PIN",
            "identifier": "0433296",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "092303",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MDCD PIN",
            "identifier": "12355900",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peggy Meents Delay, LAC
• Karel A Deleeuw, M.D.
• Brandon Salvador Deleon, MT-BC, NMT
• Francisco S Deleon, MD PA
• Yessenia Deleon
• Jessica Delfino
• Eva Delgadillo, RBT
• Victoria D Delgadillo, LPC-24458
• Teresa Isamar Delgado Cueller
• Alberto Isaac Delgado Ortega

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2016; 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.