Individual provider Active NPI

Roland Ponarski, M.D.

  • Internal Medicine Physician
  • Monroe, LA
National Provider Identifier
1104921741
Registry record updated Dec 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
09892R Issued in LA
Practice address
2806 Mark Dr
Monroe, LA 71201-5152
Phone
(318) 460-5127
Fax
(318) 460-1967
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 09892R LA Primary

Addresses

Primary practice location

2806 Mark Dr
Monroe, LA 71201-5152

Mailing address

1455 E Bert Kouns Industrial Loop
Shreveport, LA 71105-6000
Phone (318) 798-4500

Other identifiers 1

IdentifierTypeStateIssuer
1967777MedicaidLA

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
I20080116000374 LA Practitioner - Internal Medicine 0941305023 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Highland Clinic, a Prof Med CorpGroup PAC ID 3870493463, 60 clinicians

Practice addresses (Care Compare)

1455 E Bert Koun Loop
Shreveport, LA 71105-5634
Phone (318) 798-4539

1455 E Bert Kouns
Shreveport, LA 71105-5634

1455 E Bert Kouns Industrial Loop
Shreveport, LA 71105-5634

2806 Mark Dr
Monroe, LA 71201-5152
Phone (318) 460-5127

Hospital & facility affiliations

  • Passages Hospice Hospice, Monroe, LA, CCN 191541

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
09892RLAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Group of Louisiana Inc CurrentSince Feb 1, 2013 Accepting new patients
Highland Clinic, a Prof Med Corp CurrentSince Dec 8, 2025 Accepting new patients
Physician Group of Louisiana Inc CurrentSince Feb 1, 2013 Accepting new patients
Highland Clinic, a Prof Med Corp CurrentSince Dec 8, 2025 Accepting new patients
Start Community Clinic, LLC PastSince Oct 1, 2007 Accepting new patients
Passages Hospice North - Northeast, LLC. Past Accepting new patients

Locations

2806 Mark Dr
Monroe, LA 71201
Phone (318) 322-0555

1455 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 300-3643

503 McMillan Rd
Fl 2
West Monroe, LA 71291
Phone (318) 329-3475

102 Thomas Rd
Ste 104
West Monroe, LA 71291
Phone (318) 323-1559

Organizations & group practices 6

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 1

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764806400000",
    "number": "1104921741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 E BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711056000",
            "telephone_number": "318-798-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2806 MARK DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015152",
            "telephone_number": "318-460-5127",
            "fax_number": "318-460-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONARSKI",
        "first_name": "ROLAND",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-12-04",
        "certification_date": "2025-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "09892R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1967777",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.