NPIMap

Individual provider Active NPI

Leonhard J Maendel, P.A.

  • Medical Physician Assistant
  • Boyne City, MI
National Provider Identifier
1629138854
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
5601002674 Issued in MI
Practice address
223 N Park St
Boyne City, MI 49712-1220
Phone
(231) 582-5314
Fax
(231) 582-5338
NPI assigned
Dec 11, 2006
Last updated
Feb 14, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601002674 MI Primary

Addresses

Primary practice location

223 N Park St
Boyne City, MI 49712-1220

Mailing address

1105 Sixth St
Traverse City, MI 49684-2386

Other practice location 1

1619 Anderson Rd
Petoskey, MI 49770-9256
Phone (231) 417-6000

Other identifiers 1

IdentifierTypeStateIssuer
M32390011OtherMIMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20140109000870 MI Practitioner - Physician Assistant 4688802051 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1619 Anderson Rd
Petoskey, MI 49770-9256
Phone (231) 935-0338

223 N Park St
Boyne City, MI 49712-1220

829 N Ctr Ave
MHC Omh Medical Group
Gaylord, MI 49735-1595
Phone (989) 731-7708

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Apr 28, 2025 Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Apr 28, 2025 Accepting new patients
Munson Healthcare Charlevoix Hospital CurrentSince Aug 4, 2024 Accepting new patients
Munson Healthcare Charlevoix Hospital CurrentSince Aug 4, 2024 Accepting new patients
Munson Healthcare Charlevoix Hospital Past Accepting new patients

Locations

223 N Park St
Boyne City, MI 49712
Phone (231) 582-5314

829 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100

1619 Anderson Rd
Petoskey, MI 49770
Phone (231) 417-6000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739491200000",
    "number": "1629138854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 N PARK ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121220",
            "telephone_number": "231-582-5314",
            "fax_number": "231-582-5338"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1619 Anderson Rd",
            "address_purpose": "LOCATION",
            "city": "Petoskey",
            "state": "MI",
            "postal_code": "497709256",
            "country_code": "US",
            "telephone_number": "231-417-6000",
            "fax_number": "231-417-6005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAENDEL",
        "first_name": "LEONHARD",
        "middle_name": "J",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601002674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "M32390011",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boyne City, MI

Sources for this page

Verify at the official NPI Registry.