NPIMap

Individual provider Active NPI

Leigh Ann Falcon, M.D.

  • Internal Medicine Physician
  • Port Lavaca, TX
National Provider Identifier
1871738286
Registry record updated Dec 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
N1629 Issued in TX
Practice address
1200 N Virginia St
Port Lavaca, TX 77979-2507
Phone
(361) 552-6721
Fax
(361) 552-7463
NPI assigned
Dec 14, 2008
Last updated
Dec 14, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X N1629 TX Primary

Addresses

Primary practice location

1200 N Virginia St
Port Lavaca, TX 77979-2507

Mailing address

1200 N Virginia St
Port Lavaca, TX 77979-2507
Phone (361) 552-6721

Other names 1

  • Leigh Ann Jedlicka Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090918000384 TX Practitioner - Internal Medicine 7012063860 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Baylor College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Port Lavaca Clinic Associates PAGroup PAC ID 3971565193, 4 clinicians

Practice addresses (Care Compare)

1200 N Virginia St
Port Lavaca, TX 77979-2507
Phone (361) 553-6567

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N1629TXMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Port Lavaca Clinic Associates PA Internal Medicine CurrentSince Aug 17, 2009 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients

Locations

1200 N Virginia St
Port Lavaca, TX 77979
Phone (361) 552-6721

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Port Lavaca Clinic Associates PAPort Lavaca, TX, CCN 453957 Rural health clinic 5% Or Greater Direct Ownership Interest (25%)
Corporate Officer (25%)		 Dec 4, 2017
Dec 4, 2017

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1229212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260748800000",
    "number": "1871738286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779792507",
            "telephone_number": "361-552-6721",
            "fax_number": "361-552-7463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N VIRGINIA ST",
            "city": "PORT LAVACA",
            "state": "TX",
            "postal_code": "779792507",
            "telephone_number": "361-552-6721",
            "fax_number": "361-552-7463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALCON",
        "first_name": "LEIGH",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-14",
        "last_updated": "2009-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "N1629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LEIGH",
            "last_name": "JEDLICKA",
            "middle_name": "ANN",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Port Lavaca, TX

Sources for this page

Verify at the official NPI Registry.