Organization Active NPI

Health Paradigm, LLC

  • Psychiatry Physician
  • Ruston, LA
National Provider Identifier
1235340761
Registry record updated Sep 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
1164R Issued in LA
Legal business name
HEALTH PARADIGM, LLC
Practice address
615 S Trenton St
Ruston, LA 71270-5040
Phone
(318) 251-2322
Fax
(318) 251-0710
NPI assigned
May 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2010

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

Authorized official

Name
Elisa M Vandenberg
Title
Administrator
Phone
(318) 251-2322

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X CI 3505 LA LA
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 1164R LA Primary

Addresses

Primary practice location

615 S Trenton St
Ruston, LA 71270-5040

Mailing address

615 S Trenton St
Ruston, LA 71270-5040
Phone (318) 251-2322

Other identifiers 1

IdentifierTypeStateIssuer
1681032MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110801000173 LA Part B Supplier - Clinic/Group Practice 9133397524 Receives reassigned benefits from 1 practitioner
Practice locations: Ruston, LA

National Provider Directory

National Provider Directory
Tax ID family
Health Paradigm LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

615 S Trenton St
Ruston, LA 71270
Phone (318) 251-2322

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283299200000",
    "number": "1235340761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S TRENTON ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705040",
            "telephone_number": "318-251-2322",
            "fax_number": "318-251-0710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S TRENTON ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712705040",
            "telephone_number": "318-251-2322",
            "fax_number": "318-251-0710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH PARADIGM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-25",
        "last_updated": "2010-09-01",
        "status": "A",
        "authorized_official_last_name": "VANDENBERG",
        "authorized_official_first_name": "ELISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-251-2322"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "LA",
            "license": "CI 3505 LA",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "1164R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1681032",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2010; 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.