NPIMap

Individual provider Active NPI

Philip Andrew Utter, M.D.

  • Neurological Surgery Physician
  • Shreveport, LA
National Provider Identifier
1073585477
Registry record updated Sep 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
44123 Issued in MN
Practice address
1500 Line Avenue
Ste 200
Shreveport, LA 71101
Phone
(318) 629-5555
Fax
(318) 629-5556
NPI assigned
Feb 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X 44123 MN Primary
Neurological Surgery Physician 207T00000X 91820 OH
Neurological Surgery Physician 207T00000X 202784 LA

Addresses

Primary practice location

1500 Line Avenue
Ste 200
Shreveport, LA 71101

Mailing address

1500 Line Avenue
Ste 200
Shreveport, LA 71101
Phone (318) 629-5555

Other identifiers 1

IdentifierTypeStateIssuer
200821100MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090603000108 LA Practitioner - NeurosurgeryPractitioner - Other (Physician) 3375568082 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurosurgery
Education
University of Mississippi School of Medicine, 2000
Medicare assignment
May accept Medicare assignment
Group practices
Spine Institute of Louisiana LLCGroup PAC ID 3375719446, 13 clinicians
Physical Therapy Services of West Louisiana IncGroup PAC ID 0446388763, 92 clinicians

Practice addresses (Care Compare)

1500 Line Ave
Suite 200
Shreveport, LA 71101-4643
Phone (318) 629-5560

301 W Fertitta Blvd
Leesville, LA 71446-4665
Phone (337) 238-9931

Hospital & facility affiliations

  • Elara Caring Home health agency, Bossier City, LA, CCN 197226
  • Specialists Hospital Shreveport Hospital, Shreveport, LA, CCN 190278
  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
  • Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041
  • Christus St Michael Health System Hospital, Texarkana, TX, CCN 450801
  • Christus St Frances Cabrini Hospital Hospital, Alexandria, LA, CCN 190019

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion299
Laminectomy or laminotomy (partial removal of spine bones)41

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
202784LAMDNeurological Surgery Physician
44123MNMDNeurological Surgery Physician
91820OHMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Spine Institute of Louisiana LLC CurrentSince Jan 1, 2012 Accepting new patients

Locations

1500 Line Ave
Ste 200
Shreveport, LA 71101
Phone (318) 629-5555

1500 Line Ave
Ste 100
Shreveport, LA 71101
Phone (318) 635-3052

Interoperability endpoints

  • Direct secure messaging: philip.utter.p1@direct.sil.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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 and National Provider Directory roles.

Hospital & facility affiliations 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251763200000",
    "number": "1073585477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 LINE AVENUE",
            "address_2": "STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-629-5555",
            "fax_number": "318-629-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 LINE AVENUE",
            "address_2": "STE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "71101",
            "telephone_number": "318-629-5555",
            "fax_number": "318-629-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTTER",
        "first_name": "PHILIP",
        "middle_name": "ANDREW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-02",
        "last_updated": "2009-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "MN",
            "license": "44123",
            "primary": true
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "OH",
            "license": "91820",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "LA",
            "license": "202784",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200821100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.