NPIMap

Individual provider Active NPI

Kelsey Ann Leedock, PA-C

  • Surgical Physician Assistant
  • Plains, PA
National Provider Identifier
1982031993
Registry record updated May 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
MA056395 Issued in PA
Practice address
200 S River St
Plains, PA 18705-1143
Phone
(570) 821-1100
NPI assigned
Oct 4, 2013
Last updated
May 1, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X MA056395 PA Primary

Addresses

Primary practice location

200 S River St
Plains, PA 18705-1143

Mailing address

110 Pinecrest Ave
Dallas, PA 18612-1623
Phone (570) 550-1428

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20140304000452 PA Practitioner - Physician Assistant 6305076753 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

200 E Brown St
LVPG Family Medicine Esu
East Stroudsburg, PA 18301-3006
Phone (272) 762-4378

2545 Schoenersville Rd
Bethlehem, PA 18017-7300

5649 Wynnewood Dr
Laurys Station, PA 18059-1124

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Jul 26, 2021 Accepting new patients
Family Care Centers Inc CurrentSince Jun 4, 2021 Accepting new patients
Scranton Quincy Clinic Company LLC CurrentSince Jan 6, 2020 Accepting new patients
Scranton Quincy Clinic Company LLC CurrentSince Jan 6, 2020 Accepting new patients
Lehigh Valley Physician Group CurrentSince Jul 26, 2021 Accepting new patients

Locations

2100 Mack Blvd
Fl 4
Allentown, PA 18103

150 Brooklyn St
Carbondale, PA 18407
Phone (570) 282-2031

500 Plaza Ct
East Stroudsburg, PA 18301
Phone (570) 426-2330

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

315 S Main St
Old Forge, PA 18518
Phone (570) 457-8364

200 S River St
Plains, PA 18705
Phone (570) 821-1100

Organizations & group practices 8

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 6

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": "1380844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525132800000",
    "number": "1982031993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PINECREST AVE",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186121623",
            "telephone_number": "570-550-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S RIVER ST",
            "city": "PLAINS",
            "state": "PA",
            "postal_code": "187051143",
            "telephone_number": "570-821-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEEDOCK",
        "first_name": "KELSEY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-04",
        "last_updated": "2018-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA056395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plains, PA

Sources for this page

Verify at the official NPI Registry.