Leestma Medical Clinic, Inc
Organization Active NPI Family Medicine Physician · Demotte, IN
NPI 1487986451 · NPPES record last updated May 4, 2010
Key facts
- NPI
- 1487986451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 02000641A (IN)
- Legal business name
- LEESTMA MEDICAL CLINIC, INC
- Practice address
- 519 N Halleck St
Demotte, IN 46310-9553 - Phone
- (219) 987-7750
- Fax
- (219) 987-5750
- NPI assigned
- Feb 2, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Eric J Leestma, D.O.
- Title
- President
- Phone
- (219) 987-7750
Practitioners 10
-
Micah James Leestma, D.O.
-
Adam Leestma, FNP
-
Morganne Atteberry, FNP
-
Arsenio Santiago Favor, M.D.
-
Scott N Keith, DPM
-
Stephany Sipe, NP-C
-
Frances Jean Smith, FNP
-
Stephanie Michelle Walker, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0919923 | Leestma Medical Clinic | Certificate of waiver | Sep 18, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040105000827 | IN | Part B Supplier - Clinic/Group Practice | 1850290263 |
Receives reassigned benefits from 3 practitioners Practice locations: Demotte, IN |
National Provider Directory
Locations
9855 Lincoln Plaza Way
Ste 5A
Cedar Lake, IN 46303
519 N Halleck St
Demotte, IN 46310
Phone (219) 228-4200
10107 N 575 E
Demotte, IN 46310
Phone (219) 345-5611
110 Ridge Rd
Ste 4
Munster, IN 46321
Phone (219) 803-4300
Interoperability endpoints
- https://api.platform.athenahealth.com/21537/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 02000641A | IN | Yes |
Addresses
Primary practice location
519 N Halleck St
Demotte, IN 46310-9553
Mailing address
PO Box 850
Demotte, IN 46310-0850
Phone (219) 987-7750
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 080088241 | Other | RAILROAD MEDICARE | |
| 100209310A | Medicaid | IN | |
| 000000084931 | Other | IN | ANTHEM BCBS |
Other providers in Demotte, IN
- Keener Civil Township Jasper County Ttee
- Koveck Family Dentistry LLC
- Lake Holiday Drugs Inc
- Laura Louise Langel
- Larry W. Pampel D.D.S., Inc.
- Adam Leestma
- Eric J Leestma
- Micah James Leestma
- Cheryle Rae Lewandowski
- Little Green Thumbs ABA LLC
All providers in Demotte, IN · Family Medicine Physician in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.