Individual provider Active NPI

Theodore A. Irra, MD

  • Emergency Medicine Physician
  • Metairie, LA
National Provider Identifier
1104879253
Registry record updated Sep 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
11701R Issued in LA
Practice address
3434 Houma Blvd
Suite 200
Metairie, LA 70006-4200
Phone
(504) 458-6061
Fax
(504) 866-0206
NPI assigned
May 18, 2006
Last updated
Sep 2, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 2, 2009

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 11701R LA Primary
Pediatrics Physician 208000000X MD.08928R LA
General Practice Physician 208D00000X MD.08928R LA

Addresses

Primary practice location

3434 Houma Blvd
Suite 200
Metairie, LA 70006-4200

Mailing address

3434 Houma Blvd Ste 200
Metairie, LA 70006-4278
Phone (504) 458-6061

Other identifiers 1

IdentifierTypeStateIssuer
1977276MedicaidLA

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
I20040629000661 LA Practitioner - Emergency Medicine 2163408105 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Temple University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jena Ess LLCGroup PAC ID 7810116258, 15 clinicians
Oakdale Ess LLCGroup PAC ID 7517289713, 26 clinicians

Practice addresses (Care Compare)

187 9TH St
Jena, LA 71342-3900
Phone (318) 992-9200

900 Johnson St
Tallulah, LA 71282-4537
Phone (318) 574-2374

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11701RLAMDEmergency Medicine Physician
MD.08928RLAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jena Ess LLC Emergency Medicine CurrentSince May 24, 2025 Accepting new patients
Oakdale Ess LLC Emergency Medicine CurrentSince May 1, 2024 Accepting new patients
Hospital Service District No. 2 Past Accepting new patients
Fairway Medical Urgent Care LLC Past Accepting new patients

Locations

187 Ninth St
Jena, LA 71342
Phone (318) 992-9200

207 Jefferson St
Mansfield, LA 71052
Phone (318) 871-3109

130 Hospital Dr
Oakdale, LA 71463
Phone (318) 215-3084

900 Johnson St
Tallulah, LA 71282
Phone (318) 395-2241

Organizations & group practices 4

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.

Hospital & facility affiliations 2

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251849600000",
    "number": "1104879253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 HOUMA BLVD STE 200",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700064278",
            "telephone_number": "504-458-6061",
            "fax_number": "504-866-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 HOUMA BLVD",
            "address_2": "SUITE 200",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700064200",
            "telephone_number": "504-458-6061",
            "fax_number": "504-866-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IRRA",
        "first_name": "THEODORE",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2009-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "11701R",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD.08928R",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "LA",
            "license": "MD.08928R",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1977276",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

Verify at the official NPI Registry.