Individual provider Active NPI

Leo James Phillips, PA-C

  • Physician Assistant
  • Charlotte, NC
National Provider Identifier
1801619408
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-14802 Issued in NC
Practice address
1100 Blythe Blvd
Charlotte, NC 28203-5814
Phone
(704) 355-4300
NPI assigned
Nov 4, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-14802 NC Primary

Addresses

Primary practice location

1100 Blythe Blvd
Charlotte, NC 28203-5814

Mailing address

4202 McQueen Dr
Durham, NC 27705-8807
Phone (804) 356-0999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250219001304 NC Practitioner - Physician Assistant 2062932239 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

10628 Park Rd
Charlotte, NC 28210-8407
Phone (704) 667-1000

Hospital & facility affiliations

  • Carolinas Medical Center/Behav Health Hospital, Charlotte, NC, CCN 340113
  • Carolinas Rehabilitation Inpatient rehabilitation facility, Charlotte, NC, CCN 343026

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-14802NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Feb 3, 2025 Accepting new patients
Carolinas Medical Center CurrentSince Feb 3, 2025 Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

Interoperability endpoints

  • Direct secure messaging: lphillips2897675@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1801619408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 MCQUEEN DR",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277058807",
            "telephone_number": "804-356-0999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035814",
            "telephone_number": "704-355-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "LEO",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-04",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-14802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.