Individual provider Active NPI

Jessica Leeds, MSN. ARNP, FNP-BC

  • Otolaryngology Physician
  • Carroll, IA
National Provider Identifier
1750089058
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
1740494244 Issued in IA
Practice address
311 S Clark St
Carroll, IA 51401-3038
Phone
(712) 792-4368
NPI assigned
Feb 16, 2023
Last updated
Feb 16, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 1740494244 IA Primary

Addresses

Primary practice location

311 S Clark St
Carroll, IA 51401-3038

Mailing address

PO Box 766
Carroll, IA 51401-0766
Phone (712) 792-4368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1740494244IAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellendorf ENT, P.C. Otolaryngology CurrentSince Apr 16, 2023 Accepting new patients

Locations

1124 W 20th St
Carroll, IA 51401

311 S Clark St
Carroll, IA 51401
Phone (712) 792-3581

405 S Clark St
Carroll, IA 51401
Phone (712) 792-3581

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.236

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.

NPI Registry JSON

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

{
    "created_epoch": "1676505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1750089058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 766",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514010766",
            "telephone_number": "712-792-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 S CLARK ST",
            "city": "CARROLL",
            "state": "IA",
            "postal_code": "514013038",
            "telephone_number": "712-792-4368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEEDS",
        "first_name": "JESSICA",
        "credential": "MSN. ARNP, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-16",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IA",
            "license": "1740494244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carroll, IA

Sources for this page

Verify at the official NPI Registry.