Individual provider Active NPI

Leslie Diane Rose, PAC

  • Medical Physician Assistant
  • Naples, FL
National Provider Identifier
1629266184
Registry record updated Aug 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9104323 Issued in FL
Practice address
350 7TH St N
Naples, FL 34102-5754
Phone
(239) 436-5000
NPI assigned
Oct 10, 2007
Last updated
Aug 3, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2009

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 PA9104323 FL Primary

Addresses

Primary practice location

350 7TH St N
Naples, FL 34102-5754

Mailing address

PO Box 160448
Miami, FL 33116-0448
Phone (386) 274-7800

Other identifiers 1

IdentifierTypeStateIssuer
292910400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071220000239 FL Practitioner - Physician Assistant 5991895443 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thse - Marco Urgent Care LLCGroup PAC ID 8921131475, 19 clinicians

Practice addresses (Care Compare)

40 S Heathwood Dr
Marco Island, FL 34145-5026
Phone (239) 394-8234

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9104323FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellmed Medical Management of Florida Inc Past Accepting new patients
Richichi Family Health PastSince Dec 5, 2005 Accepting new patients
Emergency Physicians of Naples PLLC Past Accepting new patients

Organizations & group practices 5

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 1

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": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249257600000",
    "number": "1629266184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160448",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331160448",
            "telephone_number": "386-274-7800",
            "fax_number": "386-274-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 7TH ST N",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341025754",
            "telephone_number": "239-436-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "LESLIE",
        "middle_name": "DIANE",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-10",
        "last_updated": "2009-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9104323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292910400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naples, FL

Sources for this page

Verify at the official NPI Registry.