Michael David Leach, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9103759 Issued in FL

Practice address

6716 NW 11TH Place
Ste 200
Gaineville, FL 32605-4215

Phone

(352) 331-9729

Fax

(407) 895-3608

NPI assigned

Aug 16, 2006

Sex

Male

Sole proprietor

No

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.

• Gainesville Emergency Medical Associates PA

  • Emergency Medicine Physician
  • Gainesville, FL
  • NPI 1164759890
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 27, 2016.

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477526400000",
    "number": "1992818504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6716 NW 11TH PLACE",
            "address_2": "STE 200",
            "city": "GAINEVILLE",
            "state": "FL",
            "postal_code": "326054215",
            "telephone_number": "352-331-9729",
            "fax_number": "407-895-3608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6716 NW 11TH PLACE",
            "address_2": "STE 200",
            "city": "GAINEVILLE",
            "state": "FL",
            "postal_code": "326054215",
            "telephone_number": "352-331-9729",
            "fax_number": "407-895-3608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEACH",
        "first_name": "MICHAEL",
        "middle_name": "DAVID",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2016-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "Y04QN",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002619000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maria Jose Bruzzone, MD

• All providers in Gaineville, FL
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.