NPIMap

Organization Active NPI

Leavitt Womens Healthcare Corp,P.C.

  • Obstetrics & Gynecology Physician
  • Idaho Falls, ID
National Provider Identifier
1972771756
Registry record updated Oct 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
O0365 Issued in ID
Legal business name
LEAVITT WOMENS HEALTHCARE CORP,P.C.
Practice address
1550 Elk Creek Dr
Idaho Falls, ID 83404-8322
Phone
(208) 529-5942
NPI assigned
Feb 14, 2008
Last updated
Oct 1, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2014

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

Authorized official

Name
Glenn Leavitt, DONPI 1386644318
Title
Owner
Phone
(208) 529-4942

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X O0365 ID Primary

Addresses

Primary practice location

1550 Elk Creek Dr
Idaho Falls, ID 83404-8322

Mailing address

1550 Elk Creek Dr
Idaho Falls, ID 83404-8322
Phone (208) 529-5942

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060106000809 ID Part B Supplier - Clinic/Group Practice 6709809502 Receives reassigned benefits from 17 practitioners
Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Locations

1550 Elk Creek Dr
Idaho Falls, ID 83404
Phone (208) 524-6308

3339 Valencia Dr
Idaho Falls, ID 83404
Phone (208) 524-6308

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIEEDD

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412121600000",
    "number": "1972771756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-529-5942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 ELK CREEK DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048322",
            "telephone_number": "208-529-5942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEAVITT WOMENS HEALTHCARE CORP,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2014-10-01",
        "status": "A",
        "authorized_official_last_name": "LEAVITT",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-529-4942",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "ID",
            "license": "O0365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.