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LEONARD R BERTHEAU D.O.
NPI 1912079500
Internal Medicine - Diabetology in Pawtucket, RI

Active since November 15, 2006PECOS EnrolledAccepts Medicare Assignment
97.83/100
CMS Quality Rating
111 BREWSTER ST, PAWTUCKET, RI 02860(401) 729-2304(401) 729-2923 Get Directions Write a Review

NPPES record last updated: December 18, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 18, 2025, Jul 9, 2024, Apr 11, 2024 and 1 more (4 updates tracked since 2022).

About Leonard R Bertheau D.o. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LEONARD R BERTHEAU D.O. (NPI 1912079500) is an individual diabetology provider in Pawtucket, Rhode Island, licensed in Rhode Island (DO01307) and active in the NPI registry since November 2006. He is enrolled in Medicare PECOS, is affiliated with South County Hospital Inc, and is a graduate of Oklahoma State University College Of Osteopathic Medicine (2004).

NPPES Registry Identity

NPI1912079500
Entity TypeIndividualMale
Primary Taxonomy207QD0401X
Provider Legal NameLEONARD R BERTHEAUCredential: D.O.
Location Address111 BREWSTER STPawtucket, RI 02860-4400
Mailing Address455 Toll Gate RdWarwick, RI 02886-2759 · (401) 273-0641 · Fax (401) 273-2919
Phone(401) 729-2304
Fax(401) 729-2923
Sole ProprietorNo
Medical School CMSOklahoma State University College Of Osteopathic MedicineGraduated 2004
Enumeration DateNovember 15, 2006
Last NPPES UpdateDecember 18, 20254 updates tracked since enumeration
NPPES CertifiedDecember 18, 2025
✔ NPI 1912079500 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · DiabetologyAllopathic & Osteopathic Physicians
Taxonomy Code207QD0401X
License✔ Licensed in RI · DO01307
Definition
An internist who specializes in diagnosis and management of type 1, type 2, gestational, and atypical diabetes; diabetes complications; hospital management of diabetic patients; use of technology in the treatment and monitoring of diabetes; management of ancillary diagnoses, such as hypertension, obesity, lipidemia, etc.; and education and counseling on nutrition and lifestyle management.
Also ListedFamily MedicineTaxonomy 207Q00000X · License DO01307 (RI)
111 BREWSTER ST, Pawtucket, RI 02860
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Leonard R Bertheau D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729170402
PECOS Enrollment IDI20240215003557
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Leonard Bertheau reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Affinity Physicians LLC
4.5 mi
Anesthesiology
101 DUDLEY STREET, WIH DEPT OF ANESTHESIOLOGY
Providence, RI 02905
  • Reassigned Medicare billing, Rhode Island enrollment
  • 984 clinicians in this Medicare group
NPI 1053038471 (401) 274-1122

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
82 services78 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
31 services31 patients
Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report 95251
This procedure involves placing a small sensor under your skin to continuously monitor your blood sugar levels in tissue fluid. The data is interpreted and a report is generated to help manage your diabetes more effectively.
16 services15 patients
Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes 99222
Initial hospital inpatient care is a service where a healthcare provider spends about 50 minutes per day overseeing your care while you're admitted in the hospital. This includes reviewing your health status, planning your treatment, and ensuring your safety and comfort.
15 services13 patients

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

South County Hospital Inc

Acute Care Hospitals · Wakefield, RI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number410008
Location100 Kenyon AveWakefield, RI 02879 · Washington County
Emergency services Birthing friendly

Kent County Memorial Hospital

Acute Care Hospitals · Warwick, RI
3/5 CMS rating
OwnershipProprietary
CMS Certification Number410009
Location455 Toll Gate RdWarwick, RI 02886 · Kent County
Emergency services Birthing friendly

Women & Infants Hospital Of Rhode Island

Acute Care Hospitals · Providence, RI
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number410010
Location101 Dudley StreetProvidence, RI 02905 · Providence County
Emergency services Birthing friendly

The Miriam Hospital

Acute Care Hospitals · Providence, RI
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number410012
Location164 Summit AvenueProvidence, RI 02906 · Providence County
Emergency services

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

97.83/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality80.97
Promoting Interoperability100
Improvement Activities40

Referred Medical Equipment & Supplies CMS DME claims 10

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supplies for maintenance of insulin infusion catheter, per week A4224
DME-Other DME · category DE017N
9 suppliers69 claims860 services$17.83 avg. paid by Medicare
Supplies for external insulin infusion pump, syringe type cartridge, sterile, each A4225
DME-Other DME · category DE017N
8 suppliers67 claims2,198 services$2.24 avg. paid by Medicare
Supply allowance for adjunctive continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service A4238
DME-Medical/Surgical Supplies · category DA000N
3 suppliers13 claims13 services$162.78 avg. paid by Medicare
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253
DME-Other DME · category DE017N
63 suppliers176 claims761 services$5.90 avg. paid by Medicare
Normal, low and high calibrator solution / chips A4256
DME-Other DME · category DE000N
3 suppliers12 claims12 services$2.94 avg. paid by Medicare
Lancets, per box of 100 A4259
DME-Medical/Surgical Supplies · category DA000N
36 suppliers62 claims137 services$1.11 avg. paid by Medicare
Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAHMOUD MOWAFY M.D.
Internal Medicine
111 BREWSTER ST
PAWTUCKET, RI 02860
Providence County (401) 729-2258
ASHLEY NANCY MASTRANGELO DPM
Podiatrist (Foot & Ankle Surgery)
111 BREWSTER ST
PAWTUCKET, RI 02860
Providence County (401) 729-2977
JOHN RIEDEL MD
Emergency Medicine
111 BREWSTER ST, DEPARTMENT OF EMERGENCY MEDICINE
PAWTUCKET, RI 02860
Providence County (401) 729-2191
MEMORIAL HOSPITAL
General Acute Care Hospital
111 BREWSTER ST
PAWTUCKET, RI 02860
Providence County (401) 729-2836
JALEH FALLAH MD
Internal Medicine (Hematology & Oncology)
111 BREWSTER ST
PAWTUCKET, RI 02860
Providence County (401) 729-2258
MS. COLLEEN FOLEY-LUNT
Speech-Language Pathologist
111 BREWSTER ST, SPEECH LANGUAGE PATHOLOGY
PAWTUCKET, RI 02860
Providence County (508) 729-2316
MAXWELL VAN HOVEN MD
Family Medicine
111 BREWSTER ST
PAWTUCKET, RI 02860
Providence County (401) 737-7000
SCOTT MICHAEL CAMPBELL
Physical Therapist
111 BREWSTER ST, ND PHYSICAL THERAPY
PAWTUCKET, RI 02860
Providence County (401) 729-3481

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Leonard Bertheau's NPI number?

The NPI number for Leonard Bertheau is 1912079500. It was assigned to this individual provider in the NPPES registry on November 15, 2006.

Where is Leonard Bertheau located?

Leonard Bertheau practices at 111 Brewster St, Pawtucket, RI 02860. The listed phone number is (401) 729-2304.

What is Leonard Bertheau's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Diabetology, with taxonomy code 207QD0401X.

Is Leonard Bertheau enrolled in Medicare?

Yes. Leonard Bertheau is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Leonard Bertheau's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Leonard Bertheau reassigns Medicare benefits to Affinity Physicians LLC (Providence, RI). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Leonard Bertheau's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Leonard Bertheau accept?

Health plans from Moda Health Plan, Inc. list Leonard Bertheau as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Leonard Bertheau affiliated with any hospitals?

According to CMS data, Leonard Bertheau is affiliated with South County Hospital Inc, Kent County Memorial Hospital, Women & Infants Hospital Of Rhode Island and The Miriam Hospital.

When was this NPI record last updated?

The NPPES record for Leonard Bertheau was last updated on December 18, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.