Individual provider Active NPI

Michael T Hayward Sr., MD

  • Family Medicine Physician
  • Monroe, LA
National Provider Identifier
1083621759
Registry record updated Jun 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD017690 Issued in LA
Practice address
3400 Medical Park Dr
Suite B
Monroe, LA 71203-2388
Phone
(318) 387-6803
Fax
(318) 387-6874
NPI assigned
Aug 2, 2006
Last updated
Jun 12, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD017690 LA Primary

Addresses

Primary practice location

3400 Medical Park Dr
Suite B
Monroe, LA 71203-2388

Mailing address

130 Desiard St
Suite 355
Monroe, LA 71201-7319
Phone (318) 807-7875

Other identifiers 1

IdentifierTypeStateIssuer
1348619MedicaidLA

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
I20101021000891 LA Practitioner - Family Practice 5799978805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as apm
Quality
60.04
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17690LAMDPharmacist
MD017690LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Health Group, LLC CurrentSince Dec 11, 2013 Accepting new patients
Affinity Health Group, LLC Family Medicine CurrentSince Dec 11, 2013 Accepting new patients

Locations

2408 Broadmoor Blvd
Ste 2
Monroe, LA 71201
Phone (318) 807-0525

130 Desiard St
Ste 355
Monroe, LA 71201
Phone (318) 807-7875

3400 Medical Park Dr
Ste B
Monroe, LA 71203
Phone (318) 387-6803

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560297600000",
    "number": "1083621759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST",
            "address_2": "SUITE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017319",
            "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": "3400 MEDICAL PARK DR",
            "address_2": "SUITE B",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712032388",
            "telephone_number": "318-387-6803",
            "fax_number": "318-387-6874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYWARD",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2019-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD017690",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1348619",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.