NPIMap

Individual provider Active NPI

John Gerard Deleonibus Jr., PA-C

  • Surgical Physician Assistant
  • Bryan, TX
National Provider Identifier
1669034310
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA14181 Issued in TX
Practice address
2800 S Texas Ave Ste 102
Bryan, TX 77802-5361
Phone
(443) 758-6090
NPI assigned
Jul 2, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Physician Assistant 363AS0400X PA14181 TX Primary

Addresses

Primary practice location

2800 S Texas Ave Ste 102
Bryan, TX 77802-5361

Mailing address

2800 S Texas Ave Ste 102
Bryan, TX 77802-5361
Phone (443) 758-6090

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL unknown
CONNECT URL unkown

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210106000546 TX Practitioner - Physician Assistant 7911310230 Reassigns benefits to 3 organizations
I20250320001462 MT Practitioner - Physician Assistant 7911310230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Billings ClinicGroup PAC ID 6002993516, 814 clinicians

Practice addresses (Care Compare)

2800 10TH Ave N
Billings, MT 59101-0703
Phone (406) 657-4000

Hospital & facility affiliations

  • Billings Clinic Hospital Hospital, Billings, MT, CCN 270004

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA14181TXMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Billings Clinic CurrentSince Mar 6, 2025 Accepting new patients
Billings Clinic CurrentSince Mar 6, 2025 Accepting new patients

Locations

801 N 29th St
Billings, MT 59101
Phone (406) 238-2210

2800 10th Ave N
Billings, MT 59101
Phone (406) 248-3290

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1669034310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 S TEXAS AVE STE 102",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778025361",
            "telephone_number": "443-758-6090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 S TEXAS AVE STE 102",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778025361",
            "telephone_number": "443-758-6090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELEONIBUS",
        "first_name": "JOHN",
        "middle_name": "GERARD",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-07-02",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA14181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "unknown",
            "affiliation": "N",
            "address_1": "111 E 210th St",
            "city": "Bronx",
            "state": "NY",
            "country_code": "US",
            "postal_code": "104672401",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "unkown",
            "affiliation": "N",
            "address_1": "2800 S Texas Ave Ste 102",
            "city": "Bryan",
            "state": "TX",
            "country_code": "US",
            "postal_code": "778025361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

Verify at the official NPI Registry.