NPIMap

Individual provider Active NPI

Leslie Madore, PA

  • Surgical Physician Assistant
  • Sandy, UT
National Provider Identifier
1649244120
Registry record updated Jan 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
9377430-1206 Issued in UT
Practice address
9720 South 1300 East
Suite E230
Sandy, UT 84094
Phone
(801) 501-2950
Fax
(801) 501-2951
NPI assigned
Feb 14, 2006
Last updated
Jan 22, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 9377430-1206 UT Primary

Addresses

Primary practice location

9720 South 1300 East
Suite E230
Sandy, UT 84094

Mailing address

9720 S 1300 E
Suite E230
Sandy, UT 84094-3712
Phone (801) 501-2950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20150623002549 UT Practitioner - Physician Assistant 0648216812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

11520 S Redwood Rd
South Jordan, UT 84095-7805
Phone (385) 887-7300

2075 N 1200
Layton, UT 84041-1611
Phone (801) 779-6200

2075 University Park Blvd
Layton, UT 84041-1611
Phone (801) 387-6200

5323 S Woodrow St
Murray, UT 84107-5841
Phone (801) 261-8346

700 S Hwy 99
Suite 3
Fillmore, UT 84631-5137
Phone (801) 357-4600

9450 S 1300
Sandy, UT 84094-5555
Phone (801) 501-6250

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1223CTMDChiropractor
001223CTMDPhysical Therapist
9377430-1206UTMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services, Inc. CurrentSince Jul 1, 2015 Accepting new patients
Ihc Health Services Inc CurrentSince Jul 1, 2015 Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley Past Accepting new patients
Ihc Health Services Inc Urology Past Accepting new patients
Mep of Bristol, LLC Past Accepting new patients
Bristol Urologic Associates PC Urology Past Accepting new patients
Franklin Medical Group, PC Past Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

3723 W 12600 S
Ste 270
Riverton, UT 84065
Phone (801) 285-4600

9450 S 1300 E
Sandy, UT 84094
Phone (801) 501-2133

354 W State Road 73
Saratoga Springs, UT 84045
Phone (801) 341-5200

Organizations & group practices 8

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": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453420800000",
    "number": "1649244120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9720 S 1300 E",
            "address_2": "SUITE E230",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840943712",
            "telephone_number": "801-501-2950",
            "fax_number": "801-501-2951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9720 SOUTH 1300 EAST",
            "address_2": "SUITE E230",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "84094",
            "telephone_number": "801-501-2950",
            "fax_number": "801-501-2951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MADORE",
        "first_name": "LESLIE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2016-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "UT",
            "license": "9377430-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy, UT

Sources for this page

Verify at the official NPI Registry.