Ofundem Rose Gwan, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD.203609 Issued in LA

Practice address

1406 S Vienna St
Ruston, LA 71270-6428

Phone

(318) 232-2456

Fax

(318) 232-2457

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ogwan374711@directhoustonmethodist.org

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.

• Main Street Physician Services LLC

  • Hospitalist Physician
  • New Iberia, LA
  • NPI 1396150785
  Medicare reassignment NPD
• Divine Health Primary Care Clinic, LLC

  dba Divine Health and Primary Care Clinic

  • Internal Medicine Physician
  • Ruston, LA
  • NPI 1548528854
  NPD (past) Authorized official
• Ruston Clinic Company LLC

  • Surgery Physician
  • Ruston, LA
  • NPI 1336292432
  NPD (past)
• St Francis Medical Center, Inc

  • Rehabilitation Hospital Unit
  • Monroe, LA
  • NPI 1013906239
  NPD (past)
• Hospital Care Consultants Region II Inc

  • Internal Medicine Physician
  • West Memphis, AR
  • NPI 1558491449
  NPD (past)

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1245440940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "282 JOHN WAYNE DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705084918",
            "telephone_number": "337-371-9670",
            "fax_number": "318-232-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 S VIENNA ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712706428",
            "telephone_number": "318-232-2456",
            "fax_number": "318-232-2457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWAN",
        "first_name": "OFUNDEM",
        "middle_name": "ROSE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD.203609",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "LA",
            "license": "MD.203609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1459330",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany B Griep
• Jenny Leigh Griggs
• Benson Albert Grigsby, M.D.
• Diana Mizell Grigsby, SPEECH PATHOLOGIST
• Jonique Guidry
• Jennifer Hadley, LCSW
• Benjamin Paschal Haley, M.D.
• Pamela Lynette Hall, MSN,APRN,PMHNP-BC
• Eldrie Hamilton
• Sydia Hamlin, LOTR

• General Practice Physician in Ruston, LA
• Providers in Ruston, LA by specialty
• General Practice Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.