Bundrick and O'Neal Plastic Surgery (AMC)

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

BUNDRICK AND O'NEAL PLASTIC SURGERY (AMC)

Practice address

2210 Line Ave
Suite 204
Shreveport, LA 71104-2152

Phone

(318) 221-9671

Fax

(318) 425-2343

NPI assigned

Mar 28, 2006

Organization subpart

No

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

Authorized official

Name

Jill Patterson

Title

Office Manager

Phone

(318) 221-9671

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paige Bundrick, MD

  • Otolaryngology Physician
  • Shreveport, LA
  • NPI 1881911683
  Medicare reassignment Care Compare group NPD
• Mary T Kim, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Shreveport, LA
  • NPI 1033192828
  Medicare reassignment Care Compare group NPD
• Barron Johns O'Neal, M.D.

  • Plastic Surgery Physician
  • Shreveport, LA
  • NPI 1184685950
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656288000000",
    "number": "1093776429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 LINE AVE",
            "address_2": "SUITE 204",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042152",
            "telephone_number": "318-221-9671",
            "fax_number": "318-425-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 LINE AVE",
            "address_2": "SUITE 204",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042152",
            "telephone_number": "318-221-9671",
            "fax_number": "318-425-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUNDRICK AND O'NEAL PLASTIC SURGERY (AMC)",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2022-06-27",
        "certification_date": "2022-06-27",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "318-221-9671"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1798908",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryan Majid Bukhari, DDS
• Tanisha Bullard
• Melonie Bullock-Sanders, N/A
• Elaine S Bullock
• Benjamin Joseph Bumgardner, D.D.S.
• Anna Kaitlyn Bundrick, BCBA
• Claude Youngblood Bundrick Jr., MD
• Jennifer K. Bundrick, MD
• Paige Bundrick, MD
• Trevor John Bunger, DO

• Plastic Surgery Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Plastic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; 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.

Verify at the official NPI Registry.