Individual provider Active NPI

Jeanette Catherine Pang, PA-C

  • Physician Assistant
  • Shreveport, LA
National Provider Identifier
1023537966
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7925 Youree Dr Ste 200
Shreveport, LA 71105-5134
Phone
(318) 212-3610
Fax
(318) 212-3709
NPI assigned
Sep 12, 2017
Last updated
Sep 3, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

7925 Youree Dr Ste 200
Shreveport, LA 71105-5134

Mailing address

7925 Youree Dr Ste 200
Shreveport, LA 71105-5134
Phone (182) 123-6103

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171027000297 LA Practitioner - Physician Assistant 5092081539 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Orthopedic ClinicGroup PAC ID 9436174489, 21 clinicians

Practice addresses (Care Compare)

7925 Youree Dr
Suite 200
Shreveport, LA 71105-5134
Phone (318) 212-3610

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christus Health Central Louisiana CurrentSince Nov 6, 2017 Accepting new patients
Christus Health Central Louisiana CurrentSince Nov 6, 2017 Accepting new patients
Hulin Urgent Care Services LLC CurrentSince Apr 25, 2019 Accepting new patients
Hulin Urgent Care Services LLC CurrentSince Apr 25, 2019 Accepting new patients
Christus Health Central Louisiana Past Accepting new patients

Locations

3311 Prescott Rd
Ste 201
Alexandria, LA 71301
Phone (318) 442-6767

3330 Masonic Dr
Alexandria, LA 71301
Phone (318) 448-6917

1633 Marvel St
Coushatta, LA 71019
Phone (318) 932-2081

1110 E Saint Peter St
New Iberia, LA 70560
Phone (337) 364-1166

3342 Bienville Rd
Ringgold, LA 71068
Phone (318) 894-9611

Interoperability endpoints

  • Direct secure messaging: jpang@direct.wkhs.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630627200000",
    "number": "1023537966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7925 YOUREE DR STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055134",
            "telephone_number": "182-123-6103",
            "fax_number": "318-212-3709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7925 YOUREE DR STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055134",
            "telephone_number": "318-212-3610",
            "fax_number": "318-212-3709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANG",
        "first_name": "JEANETTE",
        "middle_name": "CATHERINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.