Individual provider Active NPI

Robert Leach, DO

  • Emergency Medicine Physician
  • Henderson, NV
National Provider Identifier
1770575391
Registry record updated Apr 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
44077-021 Issued in WI
Practice address
2408 Tour Edition Dr
Henderson, NV 89074-8300
Phone
(414) 334-0148
NPI assigned
Aug 19, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 44077-021 WI Primary

Addresses

Primary practice location

2408 Tour Edition Dr
Henderson, NV 89074-8300

Mailing address

2408 Tour Edition Dr
Henderson, NV 89074-8300
Phone (414) 334-0148

Other identifiers 1

IdentifierTypeStateIssuer
43510200MedicaidWI

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
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
44077-021WIMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS,PHS,Naihs, Gallup Indian Medical Center CurrentSince Sep 7, 2013 Accepting new patients
Nopah Vista Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Twin Valley Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Churchill Mangat Emergency Group PC Emergency Medicine Past Accepting new patients
Emcare Physician Providers Inc Emergency Medicine Past Accepting new patients

Locations

516 E Nizhoni Blvd
Gallup, NM 87301
Phone (505) 722-1326

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": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1770575391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2408 TOUR EDITION DR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890748300",
            "telephone_number": "414-334-0148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2408 TOUR EDITION DR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890748300",
            "telephone_number": "414-334-0148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEACH",
        "first_name": "ROBERT",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WI",
            "license": "44077-021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43510200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

Verify at the official NPI Registry.