Individual provider Active NPI

Antti G Maran, MD

  • Pulmonary Disease Physician
  • Monroe, LA
National Provider Identifier
1053352328
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
04712R Issued in LA
Practice address
411 Calypso Street;
Suite 210
Monroe, LA 71201
Phone
(318) 966-6500
Fax
(318) 966-6501
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 04712R LA Primary

Addresses

Primary practice location

411 Calypso Street;
Suite 210
Monroe, LA 71201

Mailing address

411 Calypso Street;
Suite 210
Monroe, LA 71201
Phone (318) 966-6500

Other identifiers 1

IdentifierTypeStateIssuer
1301469MedicaidLA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050127000028 LA Practitioner - Pulmonary Disease 1951351998 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
04712RLAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Francis Medical Center, Inc. CurrentSince Nov 1, 2004 Accepting new patients
St Francis Medical Center, Inc Current Accepting new patients
Physician Billing SFN PastSince Nov 1, 2005 Accepting new patients
St Francis Medical Center, Inc Past Accepting new patients

Locations

309 Jackson St
Monroe, LA 71201
Phone (318) 966-4000

920 Oliver Rd
Ste B
Monroe, LA 71201
Phone (318) 327-6201

411 Calypso St
Ste 210
Monroe, LA 71201
Phone (318) 966-6500

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325808000000",
    "number": "1053352328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 CALYPSO STREET;",
            "address_2": "SUITE 210",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71201",
            "telephone_number": "318-966-6500",
            "fax_number": "318-966-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 CALYPSO STREET;",
            "address_2": "SUITE 210",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71201",
            "telephone_number": "318-966-6500",
            "fax_number": "318-966-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARAN",
        "first_name": "ANTTI",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2012-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "LA",
            "license": "04712R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1301469",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.