NPIMap

Individual provider Active NPI

Leslie Douglas Stewart, MD

  • Surgery Physician
  • Memphis, TN
National Provider Identifier
1902874282
Registry record updated Oct 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
39787 Issued in TN
Practice address
6025 Walnut Grove Road
Suite 400
Memphis, TN 38120
Phone
(901) 227-9882
Fax
(901) 227-9883
NPI assigned
Mar 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 39787 TN Primary

Addresses

Primary practice location

6025 Walnut Grove Road
Suite 400
Memphis, TN 38120

Mailing address

PO Box 405827
Atlanta, GA 30384

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20050617000397 TN Practitioner - Vascular SurgeryPractitioner - General Surgery 6709820939 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35729SCMDPharmacist
39787TNMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wound Management Specialists, LLC CurrentSince Feb 15, 2022 Accepting new patients
Integrated Wound Care Tennessee PLLC CurrentSince Mar 15, 2020 Accepting new patients
The Shriners' Hospital for Children PastSince Apr 21, 2021 Accepting new patients
Pediatric Orthotic and Prosthetic Services - Northwest, LLC PastSince Jan 1, 2025 Accepting new patients
Pediatric Orthotic and Prosthetic Services - Southeast, LLC PastSince Jan 1, 2025 Accepting new patients
Pediatric Orthotic and Prosthetic Services-West, LLC PastSince Jan 1, 2025 Accepting new patients
Shriners Hospitals for Children PastSince Jul 12, 2020 Accepting new patients
Pediatric Orthotic and Prosthetic Services - Midwest, LLC PastSince Jan 1, 2025 Accepting new patients
West Tennessee Medical Group Inc Past Accepting new patients

Locations

778 Liberty Rd
Flowood, MS 39232
Phone (601) 914-9620

434 Katherine Dr
Flowood, MS 39232
Phone (769) 216-3346

492C Cedar Ln
Teaneck, NJ 07666
Phone (201) 357-5468

6019 Walnut Grove Rd
Memphis, TN 38120
Phone (901) 226-3190

141 N McLean Blvd
Memphis, TN 38104
Phone (901) 276-2020

Ownership & related parties

All facility ownership & control disclosures 11

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

FacilityTypeRoleSince
Shriners Hospitals for ChildrenPhiladelphia, PA, CCN 393309 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 12, 2020
Shriners Hospitals for ChildrenPortland, OR, CCN 383300 Hospital Corporate Officer Jul 4, 2024
Shriners Hospitals for ChildrenSpokane, WA, CCN 503302 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 12, 2020
Shriners Hospitals for ChildrenGalveston, TX, CCN 453311 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 12, 2020
Shriners Hospitals for ChildrenHonolulu, HI, CCN 123301 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 12, 2020
Shriners Hospitals for ChildrenSacramento, CA, CCN 053311 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 7, 2016
Shriners Hospitals for ChildrenGreenville, SC, CCN 423300 Hospital Corporate Director Jul 12, 2020
Shriners Children'S OhioDayton, OH, CCN 363308 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 7, 2020
The Shriners Hospital for ChildrenBoston, MA, CCN 223304 Hospital Corporate Officer
Corporate Director		 Apr 1, 2025
Apr 21, 2021
Shriners Hospitals for ChildrenChicago, IL, CCN 143302 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 12, 2020
Shriners Hospitals for ChildrenSaint Louis, MO, CCN 263304 Hospital Corporate Officer
Corporate Director		 Jul 4, 2024
Jul 12, 2020

Owned or controlled facilities with NPI records 11

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

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477353600000",
    "number": "1902874282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 405827",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 WALNUT GROVE ROAD",
            "address_2": "SUITE 400",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38120",
            "telephone_number": "901-227-9882",
            "fax_number": "901-227-9883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEWART",
        "first_name": "LESLIE",
        "middle_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2016-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "39787",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.