NPIMap

Individual provider Active NPI

Benjamin Glenn Kidder Jr., MD

  • Neurology Physician
  • Baton Rouge, LA
National Provider Identifier
1114259975
Registry record updated Mar 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
203585 Issued in LA
Practice address
10101 Park Rowe Ave Ste 200
Baton Rouge, LA 70810-1685
Phone
(225) 769-2200
Fax
(225) 768-2185
NPI assigned
Feb 4, 2010
Last updated
Mar 23, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 203585 LA Primary

Addresses

Primary practice location

10101 Park Rowe Ave Ste 200
Baton Rouge, LA 70810-1685

Mailing address

PO Box 98509
Baton Rouge, LA 70884-9509
Phone (225) 769-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100722000655 LA Practitioner - Neurology 7719019025 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Mississippi School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Neuromedical CenterGroup PAC ID 6103716477, 114 clinicians

Practice addresses (Care Compare)

10101 Park Rowe Ave
Suite 200
Baton Rouge, LA 70810-1685
Phone 22576922002164

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.15 of 100Reported as individual
Quality
87.03
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
203585LAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neuromedical Center Neurology CurrentSince Jul 1, 2010 Accepting new patients

Locations

10101 Park Rowe Ave
Ste 200
Baton Rouge, LA 70810
Phone (225) 768-2164

5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone (225) 765-4050

Interoperability endpoints

  • Direct secure messaging: benjamin.kidder.1@25776.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1265241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269302400000",
    "number": "1114259975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 98509",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708849509",
            "telephone_number": "225-769-2200",
            "fax_number": "225-768-2185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 PARK ROWE AVE STE 200",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708101685",
            "telephone_number": "225-769-2200",
            "fax_number": "225-768-2185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIDDER",
        "first_name": "BENJAMIN",
        "middle_name": "GLENN",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-04",
        "last_updated": "2010-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "LA",
            "license": "203585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.