NPIMap

Individual provider Active NPI

Brent C Ardoin, M.D.

  • Internal Medicine Physician
  • Mamou, LA
National Provider Identifier
1265446389
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
017630 Issued in LA
Practice address
728 Poinciana Ave
Mamou, LA 70554-2208
Phone
(337) 468-0267
Fax
(337) 468-2438
NPI assigned
Jul 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 017630 LA Primary

Addresses

Primary practice location

728 Poinciana Ave
Mamou, LA 70554-2208

Mailing address

728 Poinciana Ave
Mamou, LA 70554-2208
Phone (337) 468-0267

Other identifiers 1

IdentifierTypeStateIssuer
1347698MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100823000792 LA Practitioner - Internal MedicinePractitioner - Hospice/Palliative CarePractitioner - Geriatric MedicinePractitioner - Critical Care (Intensivists) 7911031299 Practice locations: Mamou, LA

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Critical Care (Intensivists), Geriatric Medicine, Hospice/Palliative Care
Education
Louisiana State University School of Medicine in New Orleans, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Savoy Medical Management Group, IncGroup PAC ID 1557403953, shared by 13 NPIs, 37 clinicians

Practice addresses (Care Compare)

704 Poinciana Ave
Mamou, LA 70554-2224
Phone (337) 468-4038

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
017630LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Savoy Medical Management Group, Inc. Past Accepting new patients
2907 Basile SNF LLC Past Accepting new patients
FLS LLC PastSince Jan 1, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: brent.ardoin@sfce.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Savoy Care CenterMamou, LA, CCN 195619 Skilled nursing facility Adp of the SNF Jan 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • FLS LLC

    dba Savoy Care Center

    • Skilled Nursing Facility
    • Mamou, LA
    • NPI 1548993454

    Adp of the SNF

    CMS ownership

Organizations & group practices 3

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265446389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "728 POINCIANA AVE",
            "city": "MAMOU",
            "state": "LA",
            "postal_code": "705542208",
            "telephone_number": "337-468-0267",
            "fax_number": "337-468-2438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "728 POINCIANA AVE",
            "city": "MAMOU",
            "state": "LA",
            "postal_code": "705542208",
            "telephone_number": "337-468-0267",
            "fax_number": "337-468-2438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ARDOIN",
        "first_name": "BRENT",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "017630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1347698",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mamou, LA

Sources for this page

Verify at the official NPI Registry.