Active NPI
Mark Douglas Ganey, PA-C
- Physician Assistant
- Ruston, LA
National Provider Identifier
1063785681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 312368
- Practice address
- 310 W Mississippi Ave
Ruston, LA 71270-4202 - Phone
- (318) 513-1212
- NPI assigned
- Feb 13, 2012
- Last updated
- Sep 10, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 312368 | LA | Primary |
| Physician Assistant | 363A00000X | PA09803 | TX |
Addresses
Primary practice location
310 W Mississippi Ave
Ruston, LA 71270-4202
Mailing address
1705 W Kentucky Ave
Ruston, LA 71270-9582
Phone (318) 355-1373
Other practice location 1
243 Curtiss Rd
Barksdale AFB, LA 71110-2425
Phone (318) 456-6324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MCH Professional Care | Past | Accepting new patients | |
| LTP Medical Mobile, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631232000000",
"number": "1063785681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1705 W KENTUCKY AVE",
"city": "RUSTON",
"state": "LA",
"postal_code": "712709582",
"telephone_number": "318-355-1373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 W MISSISSIPPI AVE",
"city": "RUSTON",
"state": "LA",
"postal_code": "712704202",
"telephone_number": "318-513-1212"
}
],
"practiceLocations": [
{
"address_1": "243 Curtiss Rd",
"address_purpose": "LOCATION",
"city": "Barksdale AFB",
"state": "LA",
"postal_code": "711102425",
"country_code": "US",
"telephone_number": "318-456-6324",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GANEY",
"first_name": "MARK",
"middle_name": "DOUGLAS",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-02-13",
"last_updated": "2021-09-10",
"certification_date": "2021-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "LA",
"license": "312368",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA09803",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ruston, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.