Individual provider Active NPI

Richard Royal Leitzen, DPM

  • Foot & Ankle Surgery Podiatrist
  • Wheaton, IL
National Provider Identifier
1902051840
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
016.005466 Issued in IL
Practice address
705 Warrenville Rd
Suite B
Wheaton, IL 60189-6379
Phone
(630) 668-8277
Fax
(630) 668-3358
NPI assigned
Nov 19, 2008
Last updated
Jun 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X 016.005466 IL Primary

Addresses

Primary practice location

705 Warrenville Rd
Suite B
Wheaton, IL 60189-6379

Mailing address

527 Irvington CT
Bartlett, IL 60103-4653
Phone (203) 843-7167

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190618000066 FL Practitioner - Podiatry 0345410841 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scott P Kurecki DPM PAGroup PAC ID 4587794615, 2 clinicians

Practice addresses (Care Compare)

12757 S Tamiami TRL
North Port Foot and Ankle
North Port, FL 34287-1934
Phone (941) 426-1167

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue214
Removal of skin lesions20
Removal of nail tissue1727
Removal or shaving of skin growth1063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
016.005466ILMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Scott P Kurecki DPM PA CurrentSince Jul 1, 2019 Accepting new patients

Locations

12757 Tamiami Trl S
North Port, FL 34287
Phone (941) 426-1167

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 1

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 1

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": "1227052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309219200000",
    "number": "1902051840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 IRVINGTON CT",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601034653",
            "telephone_number": "203-843-7167",
            "fax_number": "630-668-3358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 WARRENVILLE RD",
            "address_2": "SUITE B",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601896379",
            "telephone_number": "630-668-8277",
            "fax_number": "630-668-3358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEITZEN",
        "first_name": "RICHARD",
        "middle_name": "ROYAL",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-19",
        "last_updated": "2011-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "IL",
            "license": "016.005466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.