Samantha Luci Leonard-Ndomb, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

4301105657 Issued in MI

Practice address

4572 County Road 61
Moose Lake, MN 55767-9401

Phone

(218) 485-2015

NPI assigned

Jul 23, 2013

Last updated

Apr 21, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Samantha Luci Leonard Former name

Medicare fee-for-service enrollment

Enrolled in MN

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

Specialty

General Surgery

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Essentia Health Moose LakeGroup PAC ID 6608290333, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Essentia Health Moose Lake Hospital, Moose Lake, MN, CCN 241350
• Essentia Health St Mary's Medical Center Hospital, Duluth, MN, CCN 240002

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: samantha.leonard.p1@direct.alleganfamilyhealth.nextgenshare.com

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.

• Essentia Health Moose Lake

  • Critical Access Hospital
  • Moose Lake, MN
  • NPI 1154959880
  Medicare reassignment Care Compare group NPD
• The Duluth Clinic LTD

  dba Essentia Health Cloquet Clinic

  • Multi-Specialty Clinic/Center
  • Cloquet, MN
  • NPI 1902563638
  Medicare reassignment Care Compare group NPD
• Pine Medical Center

  dba Essentia Health Sandstone

  • Critical Access Hospital
  • Sandstone, MN
  • NPI 1326041633
  Medicare reassignment NPD
• Essentia Health Moose Lake

  dba Essentia Health Moose Lake Clinic

  • Critical Access Hospital Clinic/Center
  • Moose Lake, MN
  • NPI 1275102048
  NPD
• Moose Lake Community Hospital District

  dba Mercy Hospital

  • Critical Access Hospital
  • Moose Lake, MN
  • NPI 1942398029
  NPD
• Pine Medical Center

  dba Essentia Health Hinckley Clinic

  • Multi-Specialty Clinic/Center
  • Hinckley, MN
  • NPI 1720859531
  NPD
• The Duluth Clinic LTD

  dba Essentia Health Grand Rapids Clinic

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MN
  • NPI 1184132664
  NPD
• The Duluth Clinic, LTD.

  dba Essentia Health Hinckley Pharmacy

  • Community/Retail Pharmacy
  • Hinckley, MN
  • NPI 1245081066
  NPD
• The Duluth Clinic, LTD

  dba Duluth Clinic

  • Anesthesiology Physician
  • Duluth, MN
  • NPI 1760417935
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Essentia Health Moose Lake

  • Critical Access Hospital
  • Moose Lake, MN
  • NPI 1154959880
  Care Compare affiliation
• Essentia Health Moose Lake

  dba Essentia Health Moose Lake Clinic

  • Critical Access Hospital Clinic/Center
  • Moose Lake, MN
  • NPI 1275102048
  Care Compare affiliation
• St Marys Medical Center

  dba Essentia Health St Marys Medical Center

  • General Acute Care Hospital
  • Duluth, MN
  • NPI 1457393035
  Care Compare affiliation
• St. Marys Medical Center

  dba SMMC Life Flight

  • Air Ambulance
  • Duluth, MN
  • NPI 1841359478

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682035200000",
    "number": "1689016354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4572 COUNTY ROAD 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679401",
            "telephone_number": "218-485-2015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "555 Linn St",
            "address_purpose": "LOCATION",
            "city": "Allegan",
            "state": "MI",
            "postal_code": "490101524",
            "country_code": "US",
            "telephone_number": "269-686-4907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEONARD-NDOMB",
        "first_name": "SAMANTHA",
        "middle_name": "LUCI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-23",
        "last_updated": "2023-04-21",
        "certification_date": "2023-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301105657",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MN",
            "license": "61823",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "LEONARD",
            "middle_name": "LUCI",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dania A. Kamp, M.D.
• Jonathan Franklin Klingaman, PMHNP
• Andrea Karin Kratzke Nelson, MD
• Katherine Marie Laney, RN
• Gregory Raymond Larson, APRN, CNP
• Rebecca Lou Lief-Kuster, SLP
• Allyson Loupe, PT
• Elizabeth Luoma, SLP
• James Alan Mach Jr.
• Kathleen Marie Madden, RPH

• Surgery Physician in Moose Lake, MN
• Providers in Moose Lake, MN by specialty
• Surgery Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.