NPIMap

Organization Active NPI

Leonard Ellison Jr MD PC

  • Internal Medicine Physician
  • Southfield, MI
National Provider Identifier
1609821537
Registry record updated Dec 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301068024 Issued in MI
Legal business name
LEONARD ELLISON JR MD PC
Practice address
17330 Northland Park CT
Southfield, MI 48075-4318
Phone
(248) 552-9500
Fax
(248) 552-8144
NPI assigned
May 22, 2006
Last updated
Dec 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2013

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

Authorized official

Name
Dr. Leonard Ellison Jr., MDNPI 1679575328
Title
Owner/Physician
Phone
(248) 552-9500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 4301068024 MI Primary

Addresses

Primary practice location

17330 Northland Park CT
Southfield, MI 48075-4318

Mailing address

17330 Northland Park CT
Southfield, MI 48075-4318
Phone (248) 552-9500

Other identifiers 3

IdentifierTypeStateIssuer
500F382740OtherMIBCBS GROUP
110F312710OtherMIBCBS
4709307MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050125000603 MI Part B Supplier - Clinic/Group Practice 2567412893 Receives reassigned benefits from 6 practitioners
Practice locations: Southfield, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388102400000",
    "number": "1609821537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17330 NORTHLAND PARK CT",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754318",
            "telephone_number": "248-552-9500",
            "fax_number": "248-552-8144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17330 NORTHLAND PARK CT",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754318",
            "telephone_number": "248-552-9500",
            "fax_number": "248-552-8144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEONARD ELLISON JR MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "last_updated": "2013-12-27",
        "status": "A",
        "authorized_official_last_name": "ELLISON",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "248-552-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301068024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "500F382740",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "110F312710",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4709307",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.