Individual provider Active NPI

Wilbert M. Leonard, D.P.M.

  • Podiatrist
  • Bloomington, IL
National Provider Identifier
1710098652
Registry record updated Aug 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
016004981 Issued in IL
Practice address
2708 McGraw Dr
Bloomington, IL 61704-6012
Phone
(309) 663-2306
Fax
(309) 662-1213
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X 016004981 IL Primary

Addresses

Primary practice location

2708 McGraw Dr
Bloomington, IL 61704-6012

Mailing address

2708 McGraw Dr
Bloomington, IL 61704-6012
Phone (309) 663-2306

Other identifiers 1

IdentifierTypeStateIssuer
016004981MedicaidIL

Other names 1

  • Marc Leonard Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051103000887 IL Practitioner - Podiatry 7517985997 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1701 E College Ave
Bloomington, IL 61704-2101
Phone (309) 664-3130

2200 E Washington St
Bloomington, IL 61701-4364
Phone (309) 662-3311

2500 W Reynolds St
Pontiac, IL 61764-9774

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue266
Removal of skin lesions13
Removal of nail tissue99
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016004981ILMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Oct 10, 2016 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

1701 E College Ave
Bloomington, IL 61704
Phone (309) 664-3000

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

2500 W Reynolds St
Ste 207203205206
Pontiac, IL 61764

Organizations & group practices 3

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 5

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470960000000",
    "number": "1710098652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 MCGRAW DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046012",
            "telephone_number": "309-663-2306",
            "fax_number": "309-662-1213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2708 MCGRAW DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046012",
            "telephone_number": "309-663-2306",
            "fax_number": "309-662-1213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEONARD",
        "first_name": "WILBERT",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2016-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016004981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004981",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARC",
            "last_name": "LEONARD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.