NPIMap

Organization Active NPI

East Jefferson Family Practice L.L.C.

  • Specialist
  • Metairie, LA
National Provider Identifier
1225085525
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
EAST JEFFERSON FAMILY PRACTICE L.L.C.
Practice address
3848 Veterans Blvd.
Suite 101
Metairie, LA 70002
Phone
(504) 885-2505
Fax
(504) 885-2510
NPI assigned
May 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

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

Authorized official

Name
Dung Tran, MDNPI 1386644342
Title
Owner
Phone
(504) 885-2505

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

3848 Veterans Blvd.
Suite 101
Metairie, LA 70002

Mailing address

PO Box 54576
New Orleans, LA 70154-4576
Phone (504) 885-2505

Other identifiers 1

IdentifierTypeStateIssuer
1123897MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060116000278 LA Part B Supplier - Clinic/Group Practice 7517981772 Receives reassigned benefits from 7 practitioners
Practice locations: Metairie, LA
O20140407001564 LA DME Supplier - Physician - Family Practice 7517981772 Practice locations: Metairie, LA

National Provider Directory

National Provider Directory
Tax ID family
East Jefferson Family Practice LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1148947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412208000000",
    "number": "1225085525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54576",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701544576",
            "telephone_number": "504-885-2505",
            "fax_number": "504-885-2510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3848 VETERANS BLVD.",
            "address_2": "SUITE 101",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "70002",
            "telephone_number": "504-885-2505",
            "fax_number": "504-885-2510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST JEFFERSON FAMILY PRACTICE L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-30",
        "last_updated": "2014-10-02",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "DUNG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-885-2505",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1123897",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; 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.