Active NPI
Guru Prasad Ghanta, M.D.
- Specialist
- Leesville, LA
National Provider Identifier
1255310199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 05477R
- Practice address
- 1015 W Fertitta Blvd
Leesville, LA 71446-4646 - Phone
- (337) 239-4130
- Fax
- (337) 238-4104
- NPI assigned
- Jan 10, 2006
- Last updated
- Jan 13, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 05477R | LA | Primary |
Addresses
Primary practice location
1015 W Fertitta Blvd
Leesville, LA 71446-4646
Mailing address
1015 W Fertitta Blvd
Leesville, LA 71446-4646
Phone (337) 239-4130
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1313998 | Medicaid | LA | |
| 720946706 | Other | LA | TAX ID # |
| 05477R | Other | LA | LA. STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05477R | LA | MD | Specialist |
Interoperability endpoints
- brhgghant@yourcarecommunity.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1294876800000",
"number": "1255310199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1015 W FERTITTA BLVD",
"city": "LEESVILLE",
"state": "LA",
"postal_code": "714464646",
"telephone_number": "337-239-4130",
"fax_number": "337-238-4104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 W FERTITTA BLVD",
"city": "LEESVILLE",
"state": "LA",
"postal_code": "714464646",
"telephone_number": "337-239-4130",
"fax_number": "337-238-4104"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHANTA",
"first_name": "GURU",
"middle_name": "PRASAD",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-10",
"last_updated": "2011-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "LA",
"license": "05477R",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1313998",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID #",
"identifier": "720946706",
"state": "LA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LA. STATE LICENSE",
"identifier": "05477R",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leesville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2011; 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.