NPIMap

Organization Active NPI

Louisiana Kidney Update, LLC

  • Nephrology Physician
  • Lafayette, LA
National Provider Identifier
1104014349
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
LOUISIANA KIDNEY UPDATE, LLC
Practice address
4811 Ambassador Caffery Pkwy FL 4
Lafayette, LA 70508-7265
Phone
(337) 839-9880
NPI assigned
Oct 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Anthony P Blalock, M.D.NPI 1124037726
Title
Partner/Physician
Phone
(337) 257-4918

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

4811 Ambassador Caffery Pkwy FL 4
Lafayette, LA 70508-7265

Mailing address

523 Beverly Dr
Lafayette, LA 70503-3113
Phone (337) 234-5541

Other practice location 1

202 Perdido Ln
Lafayette, LA 70503-5828
Phone (337) 291-2455

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180201000657 LA Part B Supplier - Clinic/Group Practice 9032479548 Receives reassigned benefits from 4 practitioners
Practice locations: Lafayette, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1192147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1104014349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 BEVERLY DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033113",
            "telephone_number": "337-234-5541",
            "fax_number": "337-593-8330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4811 AMBASSADOR CAFFERY PKWY FL 4",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705087265",
            "telephone_number": "337-839-9880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "202 Perdido Ln",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "705035828",
            "country_code": "US",
            "telephone_number": "337-291-2455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LOUISIANA KIDNEY UPDATE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-12",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "BLALOCK",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PARTNER/PHYSICIAN",
        "authorized_official_telephone_number": "337-257-4918",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.