Angela Diaz de Leon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3668 Issued in TN

Practice address

1805 Williamson CT
Brentwood, TN 37027-8164

Phone

(615) 454-6919

Fax

(615) 331-3859

NPI assigned

Oct 27, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Angela Gootee Former name

Medicare fee-for-service enrollment

Enrolled in TN

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

Specialty

Physician Assistant

Education

Lincoln Memorial University Medical Department, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ken Homolya MD LLCGroup PAC ID 5799960464, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• Ken Homolya MD LLC

  • Pain Medicine Physician
  • Hendersonville, TN
  • NPI 1619266814
  Medicare reassignment Care Compare group NPD
• Ken Homolya, MD, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Nashville, TN
  • NPI 1295209534
  NPD

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

{
    "created_epoch": "1477526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611705600000",
    "number": "1821540683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 WILLIAMSON CT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278164",
            "telephone_number": "615-454-6919",
            "fax_number": "615-331-3859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 WILLIAMSON CT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278164",
            "telephone_number": "615-454-6919",
            "fax_number": "615-331-3859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ DE LEON",
        "first_name": "ANGELA",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-27",
        "last_updated": "2021-01-27",
        "certification_date": "2021-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9109933",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "3668",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q053348",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "GOOTEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sean Devereaux
• Abigayle Lauren Dew, PMHNP, APRN, MSN
• Kelsey B Dexter, M.D.
• Micah Dial
• Lindsay Diamond, LCSW
• Jacqueline Dubois Diaz
• Mariana Diaz, CNIM
• Miriam Diaz
• Rachel Dibble, NP
• Amelia Dibiase

• Physician Assistant in Brentwood, TN
• Providers in Brentwood, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.