Individual provider Active NPI

Theresa Marie Leak-Gonzalez, MD

Internal Medicine Physician
Newburyport, MA

National Provider Identifier

1679587265

Registry record updated Nov 16, 2012

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices1
NPI Registry JSON
Other providers in Newburyport, MA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Internal Medicine PhysicianTaxonomy code 207R00000X
License: 235395 Issued in MA
Practice address: 260 Merrimac St
Newburyport, MA 01950-2192
Phone: (978) 499-7200
Fax: (978) 499-7216
NPI assigned: Jul 28, 2006
Sex: Female
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Nov 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Internal Medicine Physician	207R00000X	235395	MA	Primary

Addresses

Primary practice location

260 Merrimac St
Newburyport, MA 01950-2192

Mailing address

260 Merrimac St
Newburyport, MA 01950-2192
Phone (978) 499-7200

Other identifiers 16

Identifier	Type	State	Issuer
0844040	Other		CIGNA
1679587265	Other	MA	PHCS
J43036	Other	MA	BCBS
0045415	Other	MA	NEIGHBORHOOD HEALTH PLAN
1679587265	Other	MA	AETNA
1679587265	Other	NH	ANTHEM
1679587265	Other	MA	UNITED HEALTHCARE
95347501	Other	MA	NETWORK HEALTH
AA120030	Other	MA	HPHC
P00983236	Other	MA	RR MEDICARE
497486	Other	MA	TUFTS
110079874A	Medicaid	MA
30207840	Medicaid	NH
04-55814	Other	MA	EVERCARE
1679587265	Other	MA	BOSTON MEDICAL CENTER HEALTH PLAN
1679587265	Other	MA	FALLON COMMUNITY HEALTH PLAN

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

Part B services: Yes
Medical equipment: Yes
Home health: Yes
Power mobility devices: Yes
Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
I20180116002400	MA	Order and Referring Only - Internal MedicinePractitioner - Internal Medicine	3274622360

National Provider Directory

Medicare enrollment (NPD): Enrolled
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
235395	MA	MD	Internal Medicine Physician

Practice roles

Organization	Specialty	Status	New patients
St Vincents Hospital and Medical Center		Past	Accepting new patients

Organizations & group practices 1

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.

St Vincents Hospital and Medical Center
- Specialist
- New York, NY
- NPI 1285746354
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353024000000",
    "number": "1679587265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 MERRIMAC ST",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019502192",
            "telephone_number": "978-499-7200",
            "fax_number": "978-499-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 MERRIMAC ST",
            "city": "NEWBURYPORT",
            "state": "MA",
            "postal_code": "019502192",
            "telephone_number": "978-499-7200",
            "fax_number": "978-499-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAK-GONZALEZ",
        "first_name": "THERESA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2012-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "235395",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0844040",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "1679587265",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "J43036",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0045415",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "1679587265",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "1679587265",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1679587265",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NETWORK HEALTH",
            "identifier": "95347501",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC",
            "identifier": "AA120030",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00983236",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "497486",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110079874A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30207840",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE",
            "identifier": "04-55814",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOSTON MEDICAL CENTER HEALTH PLAN",
            "identifier": "1679587265",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FALLON COMMUNITY HEALTH PLAN",
            "identifier": "1679587265",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburyport, MA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.