Active NPI
Leslie E Fishman, MD
- Pediatrics Physician
- Avon, CO
National Provider Identifier
1902886997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 45386
- Practice address
- 50 Buck Creek Road
Suite 200
Avon, CO 81620 - Phone
- (970) 926-6340
- Fax
- (970) 926-6348
- NPI assigned
- Jan 18, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25850 | MN | |
| Pediatrics Physician | 208000000X | 45386 | CO | Primary |
Addresses
Primary practice location
50 Buck Creek Road
Suite 200
Avon, CO 81620
Mailing address
PO Box 4330
Avon, CO 81620-4330
Phone (970) 926-6340
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902886997 | Medicaid | CO | |
| 26501511 | Medicaid | CO | |
| 612272800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45386 | CO | MD | Pediatrics Physician |
| 25850 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colorado Mountain Medical, LLC | Pediatrics | Past | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487548800000",
"number": "1902886997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4330",
"city": "AVON",
"state": "CO",
"postal_code": "816204330",
"telephone_number": "970-926-6340",
"fax_number": "970-926-6355"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 BUCK CREEK ROAD",
"address_2": "SUITE 200",
"city": "AVON",
"state": "CO",
"postal_code": "81620",
"telephone_number": "970-926-6340",
"fax_number": "970-926-6348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FISHMAN",
"first_name": "LESLIE",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-18",
"last_updated": "2017-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MN",
"license": "25850",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CO",
"license": "45386",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1902886997",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "26501511",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "612272800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Avon, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.