Individual provider Active NPI

Johan Nicolaas Leeflang, PA-C

  • Physician Assistant
  • St George, UT
National Provider Identifier
1508149634
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6496047-1206 Issued in UT
Practice address
1490 E Foremaster Dr Ste 200
St George, UT 84790-4496
Phone
(435) 628-1641
NPI assigned
Sep 26, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 6496047-1206 UT Primary

Addresses

Primary practice location

1490 E Foremaster Dr Ste 200
St George, UT 84790-4496

Mailing address

1490 E Foremaster Dr Ste 200
St George, UT 84790-4496
Phone (435) 628-1641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20111115000044 UT Practitioner - Physician Assistant 0244404929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Utah Surgical Associates IncGroup PAC ID 4486686698, 48 clinicians

Practice addresses (Care Compare)

1490 E Foremaster Dr
Suite 200
Saint George, UT 84790-4496
Phone (435) 628-1641

3550 N Univ Ave
Provo, UT 84604-6685
Phone (801) 374-9625

Hospital & facility affiliations

  • St. George Regional Hospital Hospital, St George, UT, CCN 460021

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Utah Surgical Associates Surgery Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1316995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1508149634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR STE 200",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904496",
            "telephone_number": "435-628-1641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR STE 200",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904496",
            "telephone_number": "435-628-1641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEEFLANG",
        "first_name": "JOHAN",
        "middle_name": "NICOLAAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-26",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6496047-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St George, UT

Sources for this page

Verify at the official NPI Registry.