Benjamin William Leacock (NPI# 1639375140, PAC ID# 1951453463) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PEDIATRIC MEDICINE.
| Nation Provider ID (NPI) | 1639375140 |
| PAC ID by PECOS | 1951453463 |
| Professional Enrollment ID | I20100914000536 |
| Full Name | Benjamin William Leacock |
| Organization Legal Name | LAKE FOREST EMERGENCY GROUP LLC |
| Address |
100 Medical Plz Lake Saint Louis MO 63367-1366 |
| Phone Number | 6366255200 |
| Gender | M |
| Medical School | SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2007 |
| Primary Specialty | PEDIATRIC MEDICINE |
| Secondary Specialties | EMERGENCY MEDICINE |
| Group Practice PAC ID | 1759441884 |
| Number of Group Practice Members | 12 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 260200 | SSM ST JOSEPH HOSPITAL WEST |
| 150023 | UNION HOSPITAL INC |
| 260104 | SSM DEPAUL HEALTH CENTER |
| 260105 | ST LOUIS UNIVERSITY HOSPITAL |
| 140032 | ST ANTHONYS MEMORIAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 801 S Main St, Clinton, IN 47842-2261 | 7658321234 | CEP AMERICA LLC |
| 200 Health Care Dr, Greenville, IL 62246-1154 | 6186641230 | CEPAMERICA ILLINOIS LLP |
| 100 Medical Plz, Lake Saint Louis, MO 63367-1366 | 6366255200 | LAKE FOREST EMERGENCY GROUP LLC |
| 3635 Vista Ave, Saint Louis, MO 63110-2539 | 3145778000 | SLH PHYSICIANS LLC |
| 1606 N 7th St, Terre Haute, IN 47804-2706 | 8122387523 | CEP AMERICA LLC |
| Organization Legal Name | LAKE FOREST EMERGENCY GROUP LLC |
| Physicians | 9 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Gregory Dewitt Folkert | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Vincent Lawrence Boston | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Justin Rapoff | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Scott L Landry | Internal Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Victor B Bailey | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Lonnie P Moch | Nurse Practitioner | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| John E Sparks | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Leah S. Jones | Nurse Practitioner | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Street Address |
100 MEDICAL PLZ |
| City | LAKE SAINT LOUIS |
| State | MO |
| Zip | 63367-1366 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Peyman Benharash | Cardiac Surgery | The Regents of The University of California | 100 Medical Plz, Suite 630, Los Angeles, CA 90095-6997 |
| Inna Keselman | Neurology | The Regents of The University of California | 100 Medical Plz, Suite 425, Los Angeles, CA 90095-0001 |
| Andrew Jeremiah Levine | Psychologist, Clinical | The Regents of The University of California | 100 Medical Plz, Suite 425, Los Angeles, CA 90095-0001 |
| Victoria Lynn Hines | Nurse Practitioner | Forest Physician Services, LLP | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Antoinette S Gomes | Interventional Radiology | Ucla Radiology Medical Group | 100 Medical Plz, Suite 100, Los Angeles, CA 90095-0001 |
| Denise R Aberle | Diagnostic Radiology | Ucla Radiology Medical Group | 100 Medical Plz, Suite 100, Los Angeles, CA 90095-0001 |
| Patrick D Farrell | Family Medicine | Forest Physician Services, LLP | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Charles C Flippen II | Neurology | The Regents of The University of California | 100 Medical Plz, Suite 425, Los Angeles, CA 90095-0001 |
| Leif A Havton | Neurology | The Regents of The University of California | 100 Medical Plz, Suite 425, Los Angeles, CA 90095-0001 |
| John Long | Anesthesiology | Metro-west Anesthesia Group Inc | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| James David Sills Powell | Podiatry | 1309 Lake Saint Louis Blvd, Lake Saint Louis, MO 63367-1322 | |
| Gregory Dewitt Folkert | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Akiko Okabe | Nurse Practitioner | Southeastern Physician Services PC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Kathleen H Kidd | Certified Registered Nurse Anesthetist (crna) | Metro-west Anesthesia Group Inc | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Vincent Lawrence Boston | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Justin Rapoff | Emergency Medicine | Lake Forest Emergency Group LLC | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Sebastian Puig | Internal Medicine | Forest Physician Services, LLP | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Stephanie J Sellner | Certified Registered Nurse Anesthetist (crna) | Metro-west Anesthesia Group Inc | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Lizzy A Taylor | Nurse Practitioner | Forest Physician Services, LLP | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Audrey Anne Bolden | Nurse Practitioner | Forest Physician Services, LLP | 100 Medical Plz, Lake Saint Louis, MO 63367-1366 |
| Find all physicians in zip 63367 | |||
| City | LAKE SAINT LOUIS |
| Zip Code | 63367 |
| Specialty | PEDIATRIC MEDICINE |
| City + Specialty | LAKE SAINT LOUIS + PEDIATRIC MEDICINE |
Please comment or provide details below to improve the information on Benjamin William Leacock.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.