NPIMap

Organization Active NPI

Southeast Neuroscience Center, LLC

Doing business as Imaging Center of South Louisiana

  • Specialist
  • Gray, LA
National Provider Identifier
1285630129
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTHEAST NEUROSCIENCE CENTER, LLC
Doing business as
Imaging Center of South Louisiana
Practice address
128 Neuroscience CT
Gray, LA 70359
Phone
(985) 917-3007
Fax
(985) 917-3010
NPI assigned
Jun 24, 2005
Last updated
Apr 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Authorized official

Name
Jasmine MartinesNPI 1922762541
Title
Billing
Phone
(985) 855-4327

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X LA Primary

Addresses

Primary practice location

128 Neuroscience CT
Gray, LA 70359

Mailing address

128 Neuroscience CT
Gray, LA 70359-5209
Phone (985) 917-3007

Other identifiers 1

IdentifierTypeStateIssuer
1947482MedicaidLA

Other names 1

  • Imaging Center of South Louisiana Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000063 LA Part B Supplier - Clinic/Group Practice 9032010558 Receives reassigned benefits from 10 practitioners
Practice locations: Metairie, LA; Gray, LA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2083528Southeast Neuroscience Center128 Neuroscience Court, Gray, LA 70359Certificate of waiverSep 7, 2026

National Provider Directory

National Provider Directory

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Locations

114 Neuroscience Ct
Gray, LA 70359
Phone (985) 580-2888

128 Neuroscience Ct
Gray, LA 70359
Phone (985) 917-3007

8120 Main St
Ste 400
Houma, LA 70360
Phone (985) 917-3007

4500 York St
Ste 202
Metairie, LA 70001
Phone (504) 681-6701

6620 Riverside Dr
Ste 310
Metairie, LA 70003
Phone (985) 917-3007

Practitioners & affiliated clinicians

Practitioners 12

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": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1285630129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 NEUROSCIENCE CT",
            "city": "GRAY",
            "state": "LA",
            "postal_code": "703595209",
            "telephone_number": "985-917-3007",
            "fax_number": "985-917-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 NEUROSCIENCE CT",
            "city": "GRAY",
            "state": "LA",
            "postal_code": "70359",
            "telephone_number": "985-917-3007",
            "fax_number": "985-917-3010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST NEUROSCIENCE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A",
        "authorized_official_last_name": "MARTINES",
        "authorized_official_first_name": "JASMINE",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "985-855-4327"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1947482",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Imaging Center of South Louisiana",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gray, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.