NPIMap

Organization Active NPI

Orthopaedic Clinic of Monroe

  • Sports Medicine (Orthopaedic Surgery) Physician
  • West Monroe, LA
National Provider Identifier
1003337478
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X
Legal business name
ORTHOPAEDIC CLINIC OF MONROE
Practice address
309 McMillan Rd
West Monroe, LA 71291-5323
Phone
(318) 362-4396
Fax
(318) 361-2613
NPI assigned
Jul 6, 2017
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Kevin Goldman, CFO
Title
Administrator
Phone
(318) 362-4328

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XX0005X Primary

Addresses

Primary practice location

309 McMillan Rd
West Monroe, LA 71291-5323

Mailing address

1501 Louisville Ave
Monroe, LA 71201-6025
Phone (318) 323-8451

Other practice location 1

707 S Vienna St
Ruston, LA 71270-5845
Phone (318) 251-8001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170712004069 LA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 0840252698 Practice locations: West Monroe, LA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Orthopaedic Clinic of Monroe3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 Davenport Ave
Mer Rouge, LA 71261
Phone (318) 647-5008

1271 Lamy Ln
Ste L
Monroe, LA 71201
Phone (318) 340-9660

312 Grammont St
Ste 200
Monroe, LA 71201
Phone (318) 362-4316

1500 Commerce St
Ruston, LA 71270
Phone (318) 224-7145

309 McMillan Rd
West Monroe, LA 71291
Phone (318) 362-4396

5500 Cypress St
Ste 7
West Monroe, LA 71291
Phone (318) 807-1400

Practitioners & affiliated clinicians

Practitioners 59

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 59

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1003337478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 LOUISVILLE AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712016025",
            "telephone_number": "318-323-8451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 MCMILLAN RD",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712915323",
            "telephone_number": "318-362-4396",
            "fax_number": "318-361-2613"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 S Vienna St",
            "address_purpose": "LOCATION",
            "city": "Ruston",
            "state": "LA",
            "postal_code": "712705845",
            "country_code": "US",
            "telephone_number": "318-251-8001",
            "fax_number": "318-361-2613",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ORTHOPAEDIC CLINIC OF MONROE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-06",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-362-4328",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.