Active NPI
Leon H Kircik, MD
- Dermatology Physician
- Lousiville, KY
National Provider Identifier
1760576599
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 31894
- Practice address
- 1169 Eastern Pkwy 2310
Lousiville, KY 40217 - Phone
- (502) 456-2783
- Fax
- (502) 456-2728
- NPI assigned
- Oct 3, 2006
- Last updated
- Mar 20, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 31894 | KY | Primary |
Addresses
Primary practice location
1169 Eastern Pkwy 2310
Lousiville, KY 40217
Mailing address
1169 Eastern Pkwy 2310
Lousiville, KY 40217
Phone (502) 451-9000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 64318942 | Medicaid | KY |
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2025 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Staten Island Oral & Maxillofacial Surgery | Past | Accepting new patients |
Networks
- Healthfirst Medicare Network H5989
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H3359
Organizations & group practices 2
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.
-
- Dermatology Physician
- Louisville, KY
- NPI 1750564530
-
- Oral and Maxillofacial Surgery (Dentist)
- Staten Island, NY
- NPI 1316217763
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584662400000",
"number": "1760576599",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1169 EASTERN PKWY 2310",
"city": "LOUSIVILLE",
"state": "KY",
"postal_code": "40217",
"telephone_number": "502-451-9000",
"fax_number": "502-456-2728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1169 EASTERN PKWY 2310",
"city": "LOUSIVILLE",
"state": "KY",
"postal_code": "40217",
"telephone_number": "502-456-2783",
"fax_number": "502-456-2728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRCIK",
"first_name": "LEON",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2020-03-20",
"certification_date": "2020-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "KY",
"license": "31894",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64318942",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lousiville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.