KEITH JAMES LEAVELL (NPI# 1184606311) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184606311 |
| Entity Type | Individual |
| Full Name | KEITH JAMES LEAVELL |
| Credential | MD |
| Practice Address |
1200 6th Ave N Centracare Clinic Saint Cloud MN 56303-2735 |
| Practice Telephone | 3202525131 |
| Practice Fax Number | 3202402118 |
| Mailing Telephone | 3202525131 |
| Mailing Fax Number | 3202402118 |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2013-08-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
34628 | MN | Allopathic & Osteopathic Physicians |
| N | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
34628 | MN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RR MEDICARE | 110122640 | 01 | |
| MMSI | COMP | 01 | |
| GREAT WEST | COMP | 01 | |
| ONE HEALTH PLAN | COMP | 01 | |
| PREFERRED ONE | 1011246 | 01 | |
| BLUE CROSS BLUE SHIELD | 27T22LE | 01 | |
| MEDICA HEALTH PLANS | 4800134 | 01 | |
| HEALTH PARTNERS | HP10860 | 01 | |
| FIRST HEALTH PLAN | 2114069 | 01 | |
| ARAZ GROUP | 597042 | 01 | |
| RR MEDICARE | C11369 | 01 | |
| U CARE | 112115 | 01 | |
| MEDICAL ASSISTANCE MA | 928880500 | 01 | |
| AMERICAS PPO | 597042 | 01 | |
| CHAMPUS | COMP | 01 |
| Street Address |
1200 6TH AVE N CENTRACARE CLINIC |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56303-2735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902805518 | Paul Charles Peterson | Emergency Medicine | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2005-07-15 |
| 1871127290 | Kayla Girgen | Dietitian, Registered | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2020-02-25 |
| 1023640034 | Faith Kelly Dammann | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2020-02-07 |
| 1538707377 | Alissa Wigen | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-12-11 |
| 1639713290 | Jordan Lajoie | Nurse Practitioner | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-11-06 |
| 1528602430 | Hannah Elise Osterndorf | Dietitian, Registered | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-11-04 |
| 1558919100 | Mergitu Megersa Gemeda | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2019-08-27 |
| 1659927879 | Jennifer Marie Bretscher | Physician Assistant | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2019-08-13 |
| 1366094302 | Laura Verley | Registered Nurse | 1200 6th Ave N, Saint Cloud, MN 56303-2736 | 2019-07-10 |
| 1063074235 | Briana Gray | Pharmacist | 1200 6th Ave N, Internal Medicine, Saint Cloud, MN 56303-2735 | 2019-07-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800463 | Daniel P Lahr | Radiologic Technologist | St Cloud Va Health Care System, 4801 Veterans Drive, St Cloud, MN 56303 | 2020-08-07 |
| 1730798398 | County of Stearns | Case Management | 705 Courthouse Square, St Cloud, MN 56303 | 2020-07-29 |
| 1669007126 | Aflah Transportation LLC | Non-emergency Medical Transport (VAN) | 3316 3rd Street North, Suite 129, Saint Cloud, MN 56303 | 2020-03-05 |
| 1609420942 | Stephanie Lynne Metzger | Nurse Practitioner | Centracare Clinic Riverc Ampus/nephrology, 1200 Sixth Ave North, St. Cloud, MN 56303 | 2019-07-25 |
| 1306406947 | Willow Tree Acupuncture LLC | Acupuncturist | 203 Cooper Ave N Suite 160, St. Cloud, MN 56303 | 2019-06-17 |
| 1821553520 | Alan Melvin Hoeper | Nurse Anesthetist, Certified Registered | Centracare Clinic Anesthesiology, 3701 12th St N, Suite 202, St. Cloud, MN 56303 | 2019-02-06 |
| 1437644465 | Brianna Larissa Justin | Speech-Language Pathologist | St. Cloud Hospital, 1406 6th Avenue N, St. Cloud, MN 56303 | 2018-06-22 |
| 1780186486 | Simplicity Health Pa | Family Medicine | 1511 Northway Dr Ste 103, Saint Cloud, MN 56303 | 2018-03-08 |
| 1639682925 | Dereje Beyene | Respiratory Therapist, Certified | 1406 15th Street North, Saint Cloud, MN 56303 | 2017-11-09 |
| 1740792761 | Lisa Ann Horner | Nurse Practitioner | 1555 Northway Drive #110, Centracare Complex Care Clinic, St Cloud, MN 56303 | 2017-10-31 |
| Find all providers in zip 56303 | ||||
| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245220904 | David L Shuster | Internal Medicine | 1200 6th Ave N, Saint Cloud, MN 56303-2735 | 2005-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548789910 | Sleepmedrx LLC | Internal Medicine | 7701 York Ave S Ste 100, Edina, MN 55435-5849 | 2017-09-16 |
| 1033354097 | Norman G Hepper | Internal Medicine | 1809 Hiawatha Ct Ne, Rochester, MN 55906-8014 | 2008-12-04 |
| 1841447083 | John Mcdougall | Internal Medicine | 1460 75th St Ne, Rochester, MN 55906-8903 | 2008-08-19 |
| 1396867909 | Abbie Lynn Begnaud | Internal Medicine | 516 Delaware Street, Clinic 6a, Umphysicians Medicine Specialties Clinic, Minneapolis, MN 55455 | 2007-04-04 |
| 1114068863 | Northwind Lung Specialists, P.a. | Internal Medicine | 3758 Coon Rapids Blvd Nw, Coon Rapids, MN 55433-2629 | 2007-02-08 |
| 1679593925 | Joan Mk Fox | Internal Medicine | 920 E 28th St # St5, Suite 700, Minneapolis, MN 55407-1139 | 2006-07-20 |
| 1871534214 | James W Leatherman | Internal Medicine | 701 Park Ave S, S1, Minneapolis, MN 55415-1623 | 2006-06-09 |
| 1649225012 | Conrad Iber | Internal Medicine | 606 24th Avenue South, Suite 106, Ump Sleep Medicine Clinic, Minneapolis, MN 55454-1437 | 2006-05-24 |
| 1831162395 | Jannica L Groom | Internal Medicine | 401 Phalen Boulevard, Mail Stop 41, St Paul, MN 55101-5302 | 2006-02-07 |
| 1194700864 | Sue Ann Ravenscraft | Internal Medicine | Park Nicollet Clinic Meadowbrook, 6490 Excelsior Blvd # W300, St Louis Park, MN 55426 | 2005-12-14 |
| Find all providers with the same taxonomy | ||||
| City | SAINT CLOUD |
| Zip Code | 56303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.