Active NPI
Iker Leycegui-Gardoqui, MD
- Internal Medicine Physician
- Port St Lucie, FL
National Provider Identifier
1568556546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME 95881
- Practice address
- 145 NW Central Park PLZ
Suite 101
Port St Lucie, FL 34986-2482 - Phone
- (772) 873-1919
- Fax
- (772) 873-1171
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME 95881 | FL | Primary |
Addresses
Primary practice location
145 NW Central Park PLZ
Suite 101
Port St Lucie, FL 34986-2482
Mailing address
145 NW Central Park PLZ
Suite 101
Port St Lucie, FL 34986-2482
Phone (772) 873-1919
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AB628Y | Other | FL | MEDICARE PTAN |
| 277512300 | Medicaid | FL | |
| CU246A | Other | FL | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 95881 | FL | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427760000000",
"number": "1568556546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 NW CENTRAL PARK PLZ",
"address_2": "SUITE 101",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349862482",
"telephone_number": "772-873-1919",
"fax_number": "772-873-1171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 NW CENTRAL PARK PLZ",
"address_2": "SUITE 101",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349862482",
"telephone_number": "772-873-1919",
"fax_number": "772-873-1171"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEYCEGUI-GARDOQUI",
"first_name": "IKER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2015-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME 95881",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "AB628Y",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "277512300",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "CU246A",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.