Individual provider Active NPI

Leslie E Everts, MD

  • Family Medicine Physician
  • Springfield, PA
National Provider Identifier
1750434692
Registry record updated May 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD047549L Issued in PA
Practice address
1260 E Woodland Ave
Springfield, PA 19064-3969
Phone
(610) 690-4490
Fax
(610) 328-9391
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD047549L PA Primary

Addresses

Primary practice location

1260 E Woodland Ave
Springfield, PA 19064-3969

Mailing address

1601 Cherry St
Suite 11511
Philadelphia, PA 19102-1320
Phone (215) 255-7822

Other identifiers 1

IdentifierTypeStateIssuer
014631970MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20100223000053 PA Practitioner - Family Practice 6901940428 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD047549LPAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Temple University of the Commonwealth System of Higher Education CurrentSince Aug 10, 2021 Accepting new patients

Locations

1700 N Broad St
Ste 4
Philadelphia, PA 19121
Phone (215) 204-2679

1700 N Broad St
Philadelphia, PA 19121
Phone (215) 204-2679

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462924800000",
    "number": "1750434692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 CHERRY ST",
            "address_2": "SUITE 11511",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191021320",
            "telephone_number": "215-255-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 E WOODLAND AVE",
            "city": "SPRINGFIELD",
            "state": "PA",
            "postal_code": "190643969",
            "telephone_number": "610-690-4490",
            "fax_number": "610-328-9391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERTS",
        "first_name": "LESLIE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2016-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD047549L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "014631970",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, PA

Sources for this page

Verify at the official NPI Registry.