Individual provider Active NPI

Leah J Treadwell, MD

  • Family Medicine Physician
  • Kyle, TX
National Provider Identifier
1437267291
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M4601 Issued in TX
Practice address
4100 Everett Dr Ste 400
Kyle, TX 78640-6147
Phone
(512) 295-1333
Fax
(512) 406-7327
NPI assigned
Aug 29, 2006
Last updated
May 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 04-46862 KS
Family Medicine Physician 207Q00000X C183324 CA
Family Medicine Physician 207Q00000X 72413 MN
Family Medicine Physician 207Q00000X C0964 KY
Family Medicine Physician 207Q00000X MED-PHYS-LIC-9545 MT
Family Medicine Physician 207Q00000X 54637 CO
Family Medicine Physician 207Q00000X D0095422 MD
Family Medicine Physician 207Q00000X MD213434 OR
Family Medicine Physician 207Q00000X 67980 AZ
Family Medicine Physician 207Q00000X M4601 TX Primary

Addresses

Primary practice location

4100 Everett Dr Ste 400
Kyle, TX 78640-6147

Mailing address

6210 E Hwy 290
Austin, TX 78723-1142
Phone (512) 483-9596

Other identifiers 4

IdentifierTypeStateIssuer
188404103MedicaidTX
188404104MedicaidTX
188404101MedicaidTX
188404102MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070130000205 TX Practitioner - Family Practice 8224925946

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Iowa, RJ & L Carver College of Medicine, 1996
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

15 Grumman Rd W
Suite 1400
Bethpage, NY 11714-5029

4515 Seton Ctr Pkwy
Suite 215 Credentialing
Austin, TX 78759-0726

6210 E Hwy 290
Suite 420
Austin, TX 78723-1142

6210 E US Hwy 290
Suite 420
Austin, TX 78723-1098

P O Box
Suite 3409
Pflugerville, TX 78691-3409

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
67980AZMDFamily Medicine Physician
C183324CAMDFamily Medicine Physician
54637COMDFamily Medicine Physician
04-46862KSMDFamily Medicine Physician
C0964KYMDFamily Medicine Physician
D0095422MDMDFamily Medicine Physician
72413MNMDFamily Medicine Physician
MED-PHYS-LIC-9545MTMDFamily Medicine Physician
MD213434ORMDFamily Medicine Physician
M4601TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Provider Health PA Past Accepting new patients
Logan Health - Whitefish Past Accepting new patients
Family Health Care PC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716508800000",
    "number": "1437267291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6210 E HWY 290",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787231142",
            "telephone_number": "512-483-9596",
            "fax_number": "512-406-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 EVERETT DR STE 400",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786406147",
            "telephone_number": "512-295-1333",
            "fax_number": "512-406-7327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TREADWELL",
        "first_name": "LEAH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-29",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KS",
            "license": "04-46862",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C183324",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "72413",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "C0964",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-9545",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "54637",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0095422",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "MD213434",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "67980",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "M4601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188404103",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188404104",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188404101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "188404102",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kyle, TX

Sources for this page

Verify at the official NPI Registry.