NPIMap

Organization Active NPI

Jefferson Psychiatric Associates LLC

  • Psychiatry Physician
  • Metairie, LA
National Provider Identifier
1053558890
Registry record updated Jun 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
JEFFERSON PSYCHIATRIC ASSOCIATES LLC
Practice address
3901 Houma Blvd Ste 401
Metairie, LA 70006-2930
Phone
(504) 889-1448
Fax
(504) 889-1452
NPI assigned
Jan 15, 2009
Last updated
Jun 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2022

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

Authorized official

Name
Dr. Sidney Kendrick Smith III, MDNPI 1922148162
Title
Owner
Phone
(504) 889-1448

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Clinical Psychologist 103TC0700X NU
Clinical Social Worker 1041C0700X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

3901 Houma Blvd Ste 401
Metairie, LA 70006-2930

Mailing address

3901 Houma Blvd Ste 401
Metairie, LA 70006-2930
Phone (504) 889-1448

Other identifiers 1

IdentifierTypeStateIssuer
1949230MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140404001113 LA Part B Supplier - Clinic/Group Practice 9234361213 Receives reassigned benefits from 9 practitioners
Practice locations: New Orleans, LA; Harahan, LA; Metairie, LA; Kenner, LA; Destrehan, LA

National Provider Directory

National Provider Directory

Locations

3340 Severn Ave
Ste 206
Metairie, LA 70002
Phone (504) 889-1448

3901 Houma Blvd
Ste 401
Metairie, LA 70006
Phone (504) 889-1448

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/05a97b88-f719-405f-abbb-125ac71b7cee/

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1231977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655251200000",
    "number": "1053558890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 HOUMA BLVD STE 401",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700062930",
            "telephone_number": "504-889-1448",
            "fax_number": "504-889-1452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 HOUMA BLVD STE 401",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700062930",
            "telephone_number": "504-889-1448",
            "fax_number": "504-889-1452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON PSYCHIATRIC ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-15",
        "last_updated": "2022-06-15",
        "certification_date": "2022-06-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "SIDNEY",
        "authorized_official_middle_name": "KENDRICK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-889-1448",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1949230",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2022; 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.