Leonardo C Profenna, MD

Primary specialty

Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X

License

P2157 Issued in TX

Practice address

497 10TH St. Ste 104
Floresville, TX 78114

Phone

(830) 393-1400

Fax

(830) 393-1737

NPI assigned

Sep 7, 2005

Last updated

May 10, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• BST Health Services Corp

  dba The Mission at Blue Skies of Texas East

  • Skilled Nursing Facility
  • San Antonio, TX
  • NPI 1336259142

  Adp of the SNF, Corporate Director, Managing Control - Governing Body

  CMS ownership

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.

• Wilson County Memorial Hospital District

  • General Acute Care Hospital
  • Floresville, TX
  • NPI 1871599829

  Undersea and Hyperbaric Medicine

  Medicare reassignment NPD
• Wilson County Memorial Hospital District

  dba Connally Memorial Health Centers Main

  • Rural Health Clinic/Center
  • Floresville, TX
  • NPI 1417498585
  NPD

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

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1801880869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 10TH ST STE 104",
            "city": "FLORESVILLE",
            "state": "TX",
            "postal_code": "781143178",
            "telephone_number": "830-393-1730",
            "fax_number": "830-393-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 10TH ST. STE 104",
            "city": "FLORESVILLE",
            "state": "TX",
            "postal_code": "78114",
            "telephone_number": "830-393-1400",
            "fax_number": "830-393-1737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFENNA",
        "first_name": "LEONARDO",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "TX",
            "license": "P2157",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "TX",
            "license": "P2157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Poth & Balser Family Dentistry PLLC
• Larry H. Poth, D.D.S.
• Prestige Rehabilitation Services
• Pro Care Floresville LLC
• Procare Emergency Physicians Floresville PLLC
• Brittani Pruski, APRN, FNP-C
• Lana Lynne Pruski, PA-C
• Corrina Maria Ramirez-Cortez, LPC
• Carrie Ramirez-Niedenberger
• Jessica Yvonne Ramirez, PHARMACY TECHNICIAN

• Undersea and Hyperbaric Medicine (Preventive Medicine) Physician in Floresville, TX
• Providers in Floresville, TX by specialty
• Undersea and Hyperbaric Medicine (Preventive Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.