NPIMap

Individual provider Active NPI

Travis Bruce Banta, MD

  • Diagnostic Radiology Physician
  • Baton Rouge, LA
National Provider Identifier
1265964548
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
331083 Issued in LA
Practice address
5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone
(225) 757-0552
Fax
(225) 763-9997
NPI assigned
Mar 28, 2017
Last updated
Oct 20, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Diagnostic Radiology Physician 2085R0202X 91576 GA
Diagnostic Radiology Physician 2085R0202X T-3287 MS
Diagnostic Radiology Physician 2085R0202X 331083 LA Primary

Addresses

Primary practice location

5000 Hennessy Blvd
Baton Rouge, LA 70808

Mailing address

8230 Summa Ave Ste C
Baton Rouge, LA 70809-3465
Phone (225) 757-0552

Other practice location 1

2500 N State St
Department of Radiology
Jackson, MS 39216-4500
Phone (601) 815-1779

Other practice location 2

1364 Clifton Rd NE
Atlanta, GA 30322-4500
Phone (404) 778-9729

Other practice location 3

100 Womans Way
Baton Rouge, LA 70817
Phone (225) 757-0552

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, LA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220719003192 GA Practitioner - Diagnostic Radiology 5294009320 Reassigns benefits to 3 organizations
I20230717001952 LA Practitioner - Diagnostic Radiology 5294009320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Louisiana State University School of Medicine in Shreveport, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiology Associates LLCGroup PAC ID 8628041464, 83 clinicians

Practice addresses (Care Compare)

1988 Azalea Cir
Decatur, GA 30033-1936
Phone (225) 757-0552

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Phone (225) 757-0552

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
91576GAMDDiagnostic Radiology Physician
331083LAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Clinic of Monroe Single Specialty CurrentSince Feb 1, 2026 Accepting new patients
Emory Medical Care Foundation Inc Single Specialty Current Accepting new patients
Orthopaedic Clinic of Monroe Single Specialty CurrentSince Feb 1, 2026 Accepting new patients
Emory Medical Care Foundation Inc Single Specialty CurrentSince Jul 1, 2022 Accepting new patients
The Emory Clinic Inc Single Specialty CurrentSince Jul 1, 2022 Accepting new patients
Radiology Associates LLC Single Specialty CurrentSince Sep 15, 2022 Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

80 Jesse Hill Jr Dr SE
Atlanta, GA 30303
Phone (404) 616-4370

100 Womans Way
Baton Rouge, LA 70817
Phone (225) 293-2324

5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone (225) 765-4050

8230 Summa Ave
Ste C
Baton Rouge, LA 70809

1100 N 18th St
Ste 100
Monroe, LA 71201
Phone (318) 361-9900

1501 Louisville Ave
Monroe, LA 71201
Phone 31832384514310

135 Highway 402
Napoleonville, LA 70390
Phone (504) 369-3600

707 S Vienna St
Ruston, LA 71270
Phone (318) 224-3044

900 Johnson St
Tallulah, LA 71282
Phone (318) 395-2241

Interoperability endpoints

  • Direct secure messaging: tbanta21491@womanshospital.direct-ci.com

Organizations & group practices 6

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666224000000",
    "number": "1265964548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8230 SUMMA AVE STE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093465",
            "telephone_number": "225-757-0552",
            "fax_number": "225-763-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70808",
            "telephone_number": "225-757-0552",
            "fax_number": "225-763-9997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 N State St",
            "address_2": "Department of Radiology",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392164500",
            "country_code": "US",
            "telephone_number": "601-815-1779",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1364 Clifton Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303224500",
            "country_code": "US",
            "telephone_number": "404-778-9729",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 Womans Way",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "70817",
            "country_code": "US",
            "telephone_number": "225-757-0552",
            "fax_number": "225-763-9997",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANTA",
        "first_name": "TRAVIS",
        "middle_name": "BRUCE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-28",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "GA",
            "license": "91576",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MS",
            "license": "T-3287",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "331083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.