Individual provider Active NPI

Tahir M Qayyum, MD

  • Family Medicine Physician
  • Bastrop, LA
National Provider Identifier
1083714117
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10850R Issued in LA
Practice address
540 Durham St
Bastrop, LA 71220-5013
Phone
(318) 283-2200
Fax
(318) 283-1200
NPI assigned
Sep 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2025

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 10850R LA Primary

Addresses

Primary practice location

540 Durham St
Bastrop, LA 71220-5013

Mailing address

540 Durham St
Bastrop, LA 71220-5013
Phone (318) 283-2200

Other identifiers 2

IdentifierTypeStateIssuer
1680061MedicaidLA
080144244OtherLARAILROAD MEDICARE

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
I20101026000919 LA Practitioner - Family Practice 1557274834 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Icahn School of Medicine at Mount Sinai, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

540 Durham St
Bastrop, LA 71220-5013
Phone (318) 283-2200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10850RLAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
M. Tahir Qayyum, MD, PMC CurrentSince Sep 26, 1997 Accepting new patients

Locations

540 Durham St
Bastrop, LA 71220
Phone (318) 283-2200

3510 Medical Park Dr
Ste 8
Monroe, LA 71203
Phone (318) 325-3332

3510 Magnolia Cv
Ste 140
Monroe, LA 71203
Phone (318) 323-1100

Interoperability endpoints

  • Direct secure messaging: taqa4255@yourcarecommunity.org

Organizations & group practices 1

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1760313600000",
    "number": "1083714117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 DURHAM ST",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712205013",
            "telephone_number": "318-283-2200",
            "fax_number": "318-283-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 DURHAM ST",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712205013",
            "telephone_number": "318-283-2200",
            "fax_number": "318-283-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QAYYUM",
        "first_name": "TAHIR",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "10850R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1680061",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080144244",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastrop, LA

Sources for this page

Verify at the official NPI Registry.