NPIMap

Individual provider Active NPI

Constance Lee Ballem Leach, CRNP

  • Family Nurse Practitioner
  • Philadelphia, PA
National Provider Identifier
1548280381
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
SP007552 Issued in PA
Practice address
850 N 11TH St
Philadelphia, PA 19123-1957
Phone
(215) 769-1100
NPI assigned
Jul 21, 2006
Last updated
Apr 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X SP007552 PA Primary

Addresses

Primary practice location

850 N 11TH St
Philadelphia, PA 19123-1957

Mailing address

135 E Lehigh Ave
Philadelphia, PA 19125-1011
Phone (215) 425-5400

Other practice location 1

2724 N 5th St
Philadelphia, PA 19133-2701
Phone (215) 739-8777

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041020000538 PA Practitioner - Nurse Practitioner 8527029891 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2001
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4700 Wissahickon Ave
Suite 118
Philadelphia, PA 19144-4248
Phone (267) 597-3600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice & Counseling Services Network, Inc. Current Accepting new patients
Family Practice & Counseling Services Network, Inc. CurrentSince Oct 18, 2024 Accepting new patients
Public Health Management Corporation CurrentSince Jun 18, 2017 Accepting new patients
Resources for Human Development, Inc. Current Accepting new patients
Family Practice & Counseling Services Network CurrentSince Jul 18, 2025 Accepting new patients
Family Practice & Counseling Services Network, Inc. CurrentSince Oct 18, 2024 Accepting new patients
Public Health Management Corporation Current Accepting new patients
Pma Medical Specialists Past Accepting new patients
Ahpaffs,LLC PastSince Jun 4, 2021 Accepting new patients
Resources for Human Development, Inc. Past Accepting new patients
Arun K Mohanty MD, PC Past Accepting new patients
Excel Medical Center PastSince Sep 3, 2019 Accepting new patients

Locations

2300 W Master St
Philadelphia, PA 19121
Phone (267) 687-1172

4700 Wissahickon Ave
Bldg D
Philadelphia, PA 19144
Phone (215) 843-9720

4700 Wissahickon Ave
Ste 118
Philadelphia, PA 19144
Phone 26759736006771

4700 Wissahickon Ave
Ste 119
Philadelphia, PA 19144
Phone 2158439720 ext. 3640

5675 N Front St
Philadelphia, PA 19120
Phone (215) 224-0440

6120 Woodland Ave
Fl 2
Philadelphia, PA 19142
Phone (215) 727-4721

850 N 11th St
Philadelphia, PA 19123
Phone (215) 685-2684

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25233/brand/1/csg/1/fhir/r4

Organizations & group practices 12

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": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1548280381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 E LEHIGH AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191251011",
            "telephone_number": "215-425-5400",
            "fax_number": "215-425-0918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 N 11TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191231957",
            "telephone_number": "215-769-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2724 N 5th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191332701",
            "country_code": "US",
            "telephone_number": "215-739-8777",
            "fax_number": "215-739-9016",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BALLEM LEACH",
        "first_name": "CONSTANCE",
        "middle_name": "LEE",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP007552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.