Leonard Walter Douglas Jr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

11395 Issued in SC

Practice address

9237 University Blvd
N Charleston, SC 29406-9189

Phone

(843) 577-5011

Fax

(843) 863-0398

NPI assigned

Mar 17, 2006

Last updated

Mar 20, 2013By the provider in NPPES

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 2

Medicare fee-for-service enrollment

Enrolled in SC

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: leonard.douglas.1@7602.direct.athenahealth.com

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.

• SC House Calls Inc

  dba Your Health Organization

  • Family Medicine Physician
  • Columbia, SC
  • NPI 1518048859
  Medicare reassignment NPD
• SC House Calls Inc

  • Oxygen Equipment & Supplies (DME)
  • Columbia, SC
  • NPI 1073201711
  NPD
• University Specialty Clinics - University Primary Care

  • Family Medicine Physician
  • Columbia, SC
  • NPI 1578595856
  NPD (past)

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363737600000",
    "number": "1508835737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9237 UNIVERSITY BLVD",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294069189",
            "telephone_number": "843-577-5011",
            "fax_number": "843-863-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9237 UNIVERSITY BLVD",
            "city": "N CHARLESTON",
            "state": "SC",
            "postal_code": "294069189",
            "telephone_number": "843-577-5011",
            "fax_number": "843-863-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "LEONARD",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2013-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "11395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113950",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "AA50754950",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jared Samuel Dickerson, PHARMD
• Andrea L Dickinson, RNFA
• Shayna Lynn Dillane, DPT
• Crystal Dixon
• Dodababy Inc
• Trinka Ayn Douglas, RN, MSN, ACNP-BC
• Melody L Dover
• Driedlice LLC
• Diane K Dukes
• Elysa Dutton, APRN

• Family Medicine Physician in N Charleston, SC
• Providers in N Charleston, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; 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.