Active NPI
Jin-Shone Leo, M.D.
- Diagnostic Radiology Physician
- Lubbock, TX
National Provider Identifier
1689679748
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- F2323
- Practice address
- 4005 24TH St
Lubbock, TX 79410-1835 - Phone
- (806) 792-2767
- Fax
- (806) 791-6709
- NPI assigned
- Jun 16, 2005
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
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 |
|---|---|---|---|---|
| Diagnostic Radiology Physician | 2085R0202X | F2323 | TX | Primary |
Addresses
Primary practice location
4005 24TH St
Lubbock, TX 79410-1835
Mailing address
4005 24TH St
Lubbock, TX 79410-1835
Phone (806) 792-2767
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87471Y | Other | TX | BLUE CROSS |
| 625862 | Other | FIRST HEALTH | |
| X4609 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F2323 | TX | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lubbock Radiology LP | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physiological Laboratory
- Lubbock, TX
- NPI 1245236132
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689679748",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 24TH ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794101835",
"telephone_number": "806-792-2767",
"fax_number": "806-791-6709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4005 24TH ST",
"city": "LUBBOCK",
"state": "TX",
"postal_code": "794101835",
"telephone_number": "806-792-2767",
"fax_number": "806-791-6709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEO",
"first_name": "JIN-SHONE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "TX",
"license": "F2323",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "87471Y",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "625862",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "X4609",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lubbock, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.