Matthew Edwin Leafblad, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

68545 Issued in WI

Practice address

2600 Kiley Way
Plymouth, WI 53073-5020

Phone

(920) 449-7000

NPI assigned

Nov 18, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: matthew.leafblad@428902975864836.direct.elationemr.com

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

{
    "created_epoch": "1226966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1629223623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 KILEY WAY",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530735020",
            "telephone_number": "920-449-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 KILEY WAY",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530735020",
            "telephone_number": "920-449-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAFBLAD",
        "first_name": "MATTHEW",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-18",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "68545",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100023793",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Plymouth, WI
• Providers in Plymouth, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.