Fred J. Leitz III, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00015420 Issued in WA

Practice address

5814 Graham Ave
Suite 100
Sumner, WA 98390-2728

Phone

(253) 863-4474

Fax

(253) 863-4062

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199750400000",
    "number": "1437261658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5814 GRAHAM AVE",
            "address_2": "SUITE 100",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983902728",
            "telephone_number": "253-863-4474",
            "fax_number": "253-863-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5814 GRAHAM AVE",
            "address_2": "SUITE 100",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983902728",
            "telephone_number": "253-863-4474",
            "fax_number": "253-863-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEITZ",
        "first_name": "FRED",
        "middle_name": "J.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2008-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00015420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT. OF LABOR & IND.",
            "identifier": "20598",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215102",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Stacy Laine Lewis, LMP
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• Emma Loftus, ARNP-BC
• Michael J.a. Longo, DC

• Family Medicine Physician in Sumner, WA
• Providers in Sumner, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.