NPIMap

Individual provider Active NPI

Lynn Leatherwood, M.D.

  • Internal Medicine Physician
  • Gulfport, MS
National Provider Identifier
1750342986
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10834 Issued in MS
Practice address
15286 Community Rd
Gulfport, MS 39503-3509
Phone
(228) 832-5151
Fax
(228) 832-6320
NPI assigned
Mar 29, 2006
Last updated
Apr 24, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 10834 MS Primary

Addresses

Primary practice location

15286 Community Rd
Gulfport, MS 39503-3509

Mailing address

15286 Community Rd
Gulfport, MS 39503-3509
Phone (228) 832-5151

Other identifiers 2

IdentifierTypeStateIssuer
110098184OtherMSRAILROAD MEDICARE
00114491MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120518000431 MS Practitioner - Internal Medicine 3971790742 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of South Alabama College of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Exceed Physical Therapy, LLCGroup PAC ID 8123378338, 72 clinicians
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

12261 Hwy 49
Suite 1
Gulfport, MS 39503-2976
Phone (228) 265-7185

2771 Pass Rd
Suite a
Biloxi, MS 39531-2600
Phone (228) 385-4645

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal of skin lesions19

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport Current Accepting new patients
Memorial Hospital at Gulfport Internal Medicine CurrentSince Apr 2, 2017 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Apr 2, 2017 Accepting new patients

Locations

2771 Pass Rd
Ste A
Biloxi, MS 39531
Phone (228) 385-4645

12057 Highway 49
Ste C
Gulfport, MS 39503
Phone (228) 831-1140

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

1520 Broad Ave
Gulfport, MS 39501
Phone (228) 575-1865

1520 Broad Ave
Ste 300
Gulfport, MS 39501
Phone (228) 575-7500

15286 Community Rd
Gulfport, MS 39503
Phone (228) 822-6022

4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451

4500 13th St
Fl 3
Gulfport, MS 39501
Phone (228) 236-4262

Interoperability endpoints

  • Direct secure messaging: lynn.leatherwood.1@8242.direct.athenahealth.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208995200000",
    "number": "1750342986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15286 COMMUNITY RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033509",
            "telephone_number": "228-832-5151",
            "fax_number": "228-832-6320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15286 COMMUNITY RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033509",
            "telephone_number": "228-832-5151",
            "fax_number": "228-832-6320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEATHERWOOD",
        "first_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2008-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "10834",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110098184",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00114491",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

Verify at the official NPI Registry.