Individual provider Active NPI

Surinder Singh Tank, MD

  • Neonatal-Perinatal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1205003605
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
MD 205253 Issued in LA
Practice address
1453 E Bert Kouns Industrial Loop
Department of Pediatrics
Shreveport, LA 71105-6800
Phone
(318) 681-4316
Fax
(318) 675-6059
NPI assigned
May 14, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD.205253 LA
Pediatrics Physician 208000000X 002019 GA
Student in an Organized Health Care Education/Training Program 390200000X 0101247049 VA
Neonatal-Perinatal Medicine Physician 2080N0001X MD 205253 LA Primary

Addresses

Primary practice location

1453 E Bert Kouns Industrial Loop
Department of Pediatrics
Shreveport, LA 71105-6800

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 606-6400

Other practice location 1

1453 E Bert Koun Loop
Shreveport, LA 71105
Phone (318) 681-7379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120718000075 LA Practitioner - Pediatric MedicinePractitioner - Other (Physician) 5092971101 Reassigns benefits to 1 organization
I20170524002039 TX Practitioner - Pediatric Medicine 5092971101 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD 205253LAMDNeonatal-Perinatal Medicine Physician
002019GAMDPhysical Therapy Assistant
0101247049VAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Magella Medical Associates Billing, Inc. Neonatal-Perinatal Medicine CurrentSince Aug 1, 2017 Accepting new patients
Christus Trinity Clinic Texas Pediatrics CurrentSince Jul 1, 2023 Accepting new patients
Pediatrix Medical Group of Texas Billing, Inc. Pediatrics CurrentSince Apr 11, 2017 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Jul 1, 2023 Accepting new patients
Christus Health Northern Louisiana Past Accepting new patients

Locations

3330 Masonic Dr
Alexandria, LA 71301
Phone (318) 448-6917

1453 E Bert Kouns Industrial Loop
#L
Shreveport, LA 71105

1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138

7600 Beechnut St
Houston, TX 77074
Phone (713) 456-5000

3901 W 15th St
Plano, TX 75075
Phone (972) 519-1115

3001 George Bush Hwy
Ste 250
Richardson, TX 75082
Phone (888) 822-2855

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1210723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1205003605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-606-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1453 E BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711056800",
            "telephone_number": "318-681-4316",
            "fax_number": "318-675-6059"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1453 E Bert Koun Loop",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "71105",
            "country_code": "US",
            "telephone_number": "318-681-7379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANK",
        "first_name": "SURINDER",
        "middle_name": "SINGH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-14",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD.205253",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "002019",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0101247049",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "LA",
            "license": "MD 205253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.