Individual provider Active NPI

Ellie Leonard

  • Physician Assistant
  • Fort Pierce, FL
National Provider Identifier
1518334192
Registry record updated Aug 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1804 Blue Heron LN
Fort Pierce, FL 34982-8049
Phone
(423) 432-1331
NPI assigned
Aug 30, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2015

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 Primary

Addresses

Primary practice location

1804 Blue Heron LN
Fort Pierce, FL 34982-8049

Mailing address

1804 Blue Heron LN
Fort Pierce, FL 34982-8049
Phone (423) 432-1331

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20160114001907 FL Practitioner - Physician Assistant 6709189335 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aqua Dermatology of Florida, PAGroup PAC ID 1153390414, 184 clinicians

Practice addresses (Care Compare)

1015 Crosspointe Dr
Naples, FL 34110-0949
Phone (239) 596-9075

121 S State Rd
Suite 7
Wellington, FL 33414-4338
Phone (561) 463-5923

14840 Tamiami TRL
North Port, FL 34287-2701
Phone (941) 564-1542

1761 Palm Bay Rd NE
Palm Bay, FL 32905-2902
Phone (321) 244-6711

2601 S Kanner Hwy
Stuart, FL 34994-4622
Phone (772) 217-6829

301 NE 19TH Dr
Okeechobee, FL 34972-1911
Phone (863) 225-7345

5101 Okeechobee Rd
Fort Pierce, FL 34947-5415
Phone (722) 217-6153

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
FL-I Medical Services, LLC Physician Assistant CurrentSince Oct 28, 2015 Accepting new patients
FL-I Medical Services LLC Physician Assistant CurrentSince Oct 28, 2015 Accepting new patients
Naples Center for Dermatology & Riverchase Dermatology CurrentSince Sep 1, 2022 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

1700 S 23rd St
Fort Pierce, FL 34950
Phone (772) 461-4000

5101 Okeechobee Rd
Fort Pierce, FL 34947
Phone (772) 595-5995

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

1015 Crosspointe Dr
Naples, FL 34110
Phone (239) 596-9075

14840 Tamiami Trl
North Port, FL 34287
Phone (941) 564-1542

301 NE 19th Dr
Okeechobee, FL 34972
Phone (863) 357-0039

1761 Palm Bay Rd NE
Palm Bay, FL 32905
Phone (321) 220-6400

Networks

  • Freedom Health HMO Network
  • Optimum HealthCare HMO Network

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1440892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440892800000",
    "number": "1518334192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1804 BLUE HERON LN",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349828049",
            "telephone_number": "423-432-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 BLUE HERON LN",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349828049",
            "telephone_number": "423-432-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONARD",
        "first_name": "ELLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-30",
        "last_updated": "2015-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

Verify at the official NPI Registry.