NPIMap

Organization Active NPI

Ark la Tex Foot & Ankle Specialists, LLC

  • Foot & Ankle Surgery Podiatrist
  • Shreveport, LA
National Provider Identifier
1235168311
Registry record updated Feb 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
PD067R / PD207R Issued in LA
Legal business name
ARK LA TEX FOOT & ANKLE SPECIALISTS, LLC
Practice address
385 Bert Kouns
BLDG. 200
Shreveport, LA 71106-8158
Phone
(318) 687-8447
Fax
(318) 687-9950
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2020

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

Authorized official

Name
Gregory W. Bryan, DPMNPI 1528035888
Title
Owner/Manager
Phone
(318) 687-8447

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
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X PD067R / PD207R LA Primary

Addresses

Primary practice location

385 Bert Kouns
BLDG. 200
Shreveport, LA 71106-8158

Mailing address

385 Bert Kouns
BLDG. 200
Shreveport, LA 71106-8158
Phone (318) 687-8447

Other identifiers 2

IdentifierTypeStateIssuer
1706736MedicaidLA
DE9683OtherLARR MEDICARE

Other names 1

  • Ark La Tex Foot Specialists, LLC Former legal business name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060831000181 LA Part B Supplier - Clinic/Group Practice 7214931450 Receives reassigned benefits from 5 practitioners
Practice locations: Shreveport, LA; Natchitoches, LA; Bossier City, LA
O20100930036616 LA DME Supplier - Physician - Podiatry 7214931450 Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Locations

2850 Plantation Dr
Bossier City, LA 71111
Phone (318) 746-9555

385 Bert Kouns Loop
Ste 200
Shreveport, LA 71106
Phone (318) 687-8447

2508 Bert Kouns Ind Loop
Ste 204
Shreveport, LA 71118
Phone (318) 687-8447

Practitioners & affiliated clinicians

Practitioners 5

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": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582761600000",
    "number": "1235168311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "385 BERT KOUNS",
            "address_2": "BLDG. 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068158",
            "telephone_number": "318-687-8447",
            "fax_number": "318-687-9950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "385 BERT KOUNS",
            "address_2": "BLDG. 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711068158",
            "telephone_number": "318-687-8447",
            "fax_number": "318-687-9950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARK LA TEX FOOT & ANKLE SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2020-02-27",
        "certification_date": "2020-02-27",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "318-687-8447",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "LA",
            "license": "PD067R  /  PD207R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1706736",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DE9683",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ark La Tex Foot Specialists, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2020; 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.