Leonid M. Katkovsky, M.D.

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

77555 Issued in OH

Practice address

15301 Warren Shingle Rd
9TH MDG
Beale AFB, CA 95903-1907

Phone

(530) 634-4730

NPI assigned

Oct 14, 2005

Last updated

Feb 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203897600000",
    "number": "1821087719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "address_2": "9TH MDG",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "959031907",
            "telephone_number": "530-634-4730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15301 WARREN SHINGLE RD",
            "address_2": "9TH MDG",
            "city": "BEALE AFB",
            "state": "CA",
            "postal_code": "959031907",
            "telephone_number": "530-634-4730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATKOVSKY",
        "first_name": "LEONID",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2008-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "OH",
            "license": "77555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "77555",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Ray Hooker
• Melodee Jackson, PT , DPT
• Diane M Janssen, NP
• Alexander Dominic Jobrack, D.O, MPH
• Melissa G Johnson, PSYD
• Shalaleh Khoei
• Jaehong Kim, D.D.S.
• Wanetta King, LCSW
• David Scott Klajic, PHD
• Patricia Ann Knepshield, ATC

• Military Health Care Provider in Beale AFB, CA
• Providers in Beale AFB, CA by specialty
• Military Health Care Provider in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.