Individual provider Active NPI

Leigh Ann Nieto, M.D.

  • Pediatrics Physician
  • Clarksville, IN
National Provider Identifier
1740643824
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
01080796A Issued in IN
Practice address
2051 Clevidence Blvd Ste C
Clarksville, IN 47129-2278
Phone
(812) 280-6623
Fax
(812) 280-6632
NPI assigned
Apr 5, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 01080796A IN Primary

Addresses

Primary practice location

2051 Clevidence Blvd Ste C
Clarksville, IN 47129-2278

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

Other practice location 1

6913 N Main St Ste 200
Granger, IN 46530-8039
Phone (574) 647-4540

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lnieto@mybeacon.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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 IDStateProvider typePAC IDDetails
I20210917001606 IN Practitioner - Pediatric Medicine 5799076303 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Clinic, Inc Pediatrics CurrentSince Aug 1, 2021 Accepting new patients
Deaconess Clinic Inc. Current Accepting new patients
Norton Childrens Medical Group, LLC Pediatrics CurrentSince Jan 1, 2024 Accepting new patients
Deaconess Clinic Inc Pediatrics CurrentSince Aug 1, 2021 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Jan 1, 2024 Accepting new patients

Locations

2051 Clevidence Blvd
Ste C
Clarksville, IN 47129
Phone (812) 280-6623

2051 Clevidence Blvd
Ste B
Clarksville, IN 47129
Phone (502) 629-2030

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

4209 Gateway Blvd
#2
Newburgh, IN 47630
Phone (812) 492-5202

Interoperability endpoints

  • Direct secure messaging: lnieto280800@direct.nortonhealthcare.org
  • Direct secure messaging: lnieto@mybeacon.cernerdirect.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1740643824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2051 CLEVIDENCE BLVD STE C",
            "city": "CLARKSVILLE",
            "state": "IN",
            "postal_code": "471292278",
            "telephone_number": "812-280-6623",
            "fax_number": "812-280-6632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6913 N Main St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Granger",
            "state": "IN",
            "postal_code": "465308039",
            "country_code": "US",
            "telephone_number": "574-647-4540",
            "fax_number": "574-647-2567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIETO",
        "first_name": "LEIGH",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-05",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01080796A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lnieto@mybeacon.cernerdirect.com",
            "affiliation": "N",
            "address_1": "6913 N Main St Ste 200",
            "city": "Granger",
            "state": "IN",
            "country_code": "US",
            "postal_code": "465308039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clarksville, IN

Sources for this page

Verify at the official NPI Registry.