NPIMap

Individual provider Active NPI

Tom Chalermchai Rodsuwan, MD

  • Internal Medicine Physician
  • Bossier City, LA
National Provider Identifier
1124111539
Registry record updated Feb 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
022753 Issued in LA
Practice address
2400 Hospital Dr
Suite 130
Bossier City, LA 71111-2385
Phone
(318) 212-7990
Fax
(318) 212-7995
NPI assigned
Sep 30, 2006
Last updated
Feb 15, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2017

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 022753 LA Primary

Addresses

Primary practice location

2400 Hospital Dr
Suite 130
Bossier City, LA 71111-2385

Mailing address

2400 Hospital Dr
Suite 130
Bossier City, LA 71111-2385
Phone (318) 212-7990

Other identifiers 1

IdentifierTypeStateIssuer
1495514MedicaidLA

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
I20080107000206 LA Practitioner - Internal Medicine 7113007980 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in Shreveport, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Bossier HospitalistsGroup PAC ID 4486729639, 23 clinicians

Practice addresses (Care Compare)

2400 Hospital Dr
Suite 130
Bossier City, LA 71111-2385

2400 Hospital Dr
Suite 130
Bossier City, LA 71111-2386
Phone (318) 212-7990

2525 Viking Dr
Bossier City, LA 71111-2103
Phone (318) 841-2525

4405 Airline Dr
Bossier City, LA 71111-2058
Phone (318) 747-5440

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
WK Bossier Hospitalists CurrentSince Aug 1, 2008 Accepting new patients
Thomas Rodsuwan M D PMC Internal Medicine CurrentSince Dec 1, 2012 Accepting new patients
Intensive Specialty Hospital, LLC Past Accepting new patients
Willis Knighton Medical Center, Inc. Past Accepting new patients
Southerncare, Inc. Past Accepting new patients

Locations

2400 Hospital Dr
Ste 130
Bossier City, LA 71111
Phone (318) 212-7990

4405 Airline Dr
Bossier City, LA 71111
Phone (318) 424-5449

2551 Greenwood Rd
Ste 310
Shreveport, LA 71103
Phone (318) 212-4232

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
GentivaBossier City, LA, CCN 191580 Hospice Contracted Managing Employee Jun 26, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 9

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": "1159574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487116800000",
    "number": "1124111539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 130",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-212-7990",
            "fax_number": "318-212-7995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR",
            "address_2": "SUITE 130",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112385",
            "telephone_number": "318-212-7990",
            "fax_number": "318-212-7995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODSUWAN",
        "first_name": "TOM",
        "middle_name": "CHALERMCHAI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-30",
        "last_updated": "2017-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "022753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1495514",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.