NPIMap

Organization Active NPI

Advanced Anesthesia Services, LLC

  • Anesthesiology Physician
  • Gray, LA
National Provider Identifier
1114974235
Registry record updated Jul 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ADVANCED ANESTHESIA SERVICES, LLC
Practice address
149 Frontage a Rd
Gray, LA 70359-6301
Phone
(985) 580-1200
Fax
(985) 580-1218
NPI assigned
May 27, 2006
Last updated
Jul 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2007

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

Authorized official

Name
Dr. Jimmy Nolan Ponder Jr., MDNPI 1689644874
Title
Owner/Ceo
Phone
(985) 580-1200

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
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

149 Frontage a Rd
Gray, LA 70359-6301

Mailing address

149 Frontage a Rd
Gray, LA 70359-6301
Phone (985) 580-1200

Other identifiers 2

IdentifierTypeStateIssuer
1448702MedicaidLA
H2869OtherLABCBS PROVIDER NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050928000457 LA Part B Supplier - Clinic/Group Practice 0941235097 Receives reassigned benefits from 5 practitioners
Practice locations: Gray, LA

National Provider Directory

National Provider Directory

Locations

149 Frontage Road a
Gray, LA 70359
Phone (985) 580-1200

Practitioners & affiliated clinicians

Practitioners 21

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.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185408000000",
    "number": "1114974235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "149 FRONTAGE A RD",
            "city": "GRAY",
            "state": "LA",
            "postal_code": "703596301",
            "telephone_number": "985-580-1200",
            "fax_number": "985-580-1218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "149 FRONTAGE A RD",
            "city": "GRAY",
            "state": "LA",
            "postal_code": "703596301",
            "telephone_number": "985-580-1200",
            "fax_number": "985-580-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED ANESTHESIA SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2007-07-26",
        "status": "A",
        "authorized_official_last_name": "PONDER",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "NOLAN",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "985-580-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1448702",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "H2869",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gray, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.