NPIMap

Organization Active NPI

Northshore Redi-Med LLC

  • Family Medicine Physician
  • Mandeville, LA
National Provider Identifier
1295050599
Registry record updated Oct 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10199R Issued in LA
Legal business name
NORTHSHORE REDI-MED LLC
Practice address
4430 Hwy 22
Mandeville, LA 70471
Phone
(985) 626-3470
Fax
(985) 674-5377
NPI assigned
Mar 30, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2024

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

Authorized official

Name
Mohammad Naeem, AONPI 1235172354
Title
Owner
Phone
(985) 626-3470

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 10199R LA Primary

Addresses

Primary practice location

4430 Hwy 22
Mandeville, LA 70471

Mailing address

4430 Hwy 22
Mandeville, LA 70471
Phone (985) 626-3470

Other identifiers 2

IdentifierTypeStateIssuer
1652539MedicaidLA
2167529MedicaidLA

Other names 1

  • Redimed Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110610000009 LA Part B Supplier - Clinic/Group Practice 2163609660 Receives reassigned benefits from 4 practitioners
Practice locations: Mandeville, LA

National Provider Directory

National Provider Directory

Locations

4430 Highway 22
Mandeville, LA 70471
Phone (985) 386-3405

111 Allen Toussaint Blvd
Ste C
New Orleans, LA 70124
Phone (504) 286-2001

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1269907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727740800000",
    "number": "1295050599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4430 HWY 22",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70471",
            "telephone_number": "985-626-3470",
            "fax_number": "985-674-5377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 HWY 22",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "70471",
            "telephone_number": "985-626-3470",
            "fax_number": "985-674-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE REDI-MED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-30",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A",
        "authorized_official_last_name": "NAEEM",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "985-626-3470",
        "authorized_official_credential": "AO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "10199R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1652539",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2167529",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redimed",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mandeville, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.