Active NPI
Affinity Health Group LLC
- Dermatology Physician
- Monroe, LA
National Provider Identifier
1053957944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- AFFINITY HEALTH GROUP LLC
- Practice address
- 920 Oliver Rd # a
Monroe, LA 71201-5702 - Phone
- (318) 361-2136
- Fax
- (318) 812-6338
- NPI assigned
- Nov 26, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Janet L Justice
- Title
- Director of Operations
- Phone
- (318) 807-7875
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
920 Oliver Rd # a
Monroe, LA 71201-5702
Mailing address
130 Desiard St Ste 355
Monroe, LA 71201-7363
Phone (318) 807-7875
Other names 1
- Affinity Dermatology Clinic
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
Other NPIs on the same Medicare enrollment 31
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Cardiovascular Disease Physician
- Monroe, LA
- NPI 1902443310
O20080411000088
-
- Obstetrics & Gynecology Physician
- Monroe, LA
- NPI 1235702853
O20080411000088
-
- Cardiovascular Disease Physician
- Monroe, LA
- NPI 1275942757
O20080411000088
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Monroe, LA
- NPI 1205671625
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574726400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1574726400000",
"number": "1053957944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 DESIARD ST STE 355",
"city": "MONROE",
"state": "LA",
"postal_code": "712017363",
"telephone_number": "318-807-7875",
"fax_number": "318-812-6603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 OLIVER RD # A",
"city": "MONROE",
"state": "LA",
"postal_code": "712015702",
"telephone_number": "318-361-2136",
"fax_number": "318-812-6338"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AFFINITY HEALTH GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-11-26",
"last_updated": "2019-11-26",
"status": "A",
"authorized_official_last_name": "JUSTICE",
"authorized_official_first_name": "JANET",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
"authorized_official_telephone_number": "318-807-7875"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Affinity Dermatology Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2019; 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.