Individual provider Active NPI

David J Clemons, MD

  • Dermatology Physician
  • Shreveport, LA
National Provider Identifier
1306829916
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
014569 Issued in LA
Practice address
845 Olive St
Shreveport, LA 71104-2101
Phone
(318) 222-3278
Fax
(318) 421-3155
NPI assigned
Nov 29, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 014569 LA Primary

Addresses

Primary practice location

845 Olive St
Shreveport, LA 71104-2101

Mailing address

845 Olive St
Shreveport, LA 71104-2101
Phone (318) 222-3278

Other identifiers 1

IdentifierTypeStateIssuer
1318680MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040329001440 LA Practitioner - Dermatology 5991697377 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Louisiana State University School of Medicine in Shreveport, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology and Skin Surgery ApmcGroup PAC ID 5294627683, 9 clinicians

Practice addresses (Care Compare)

9007 Ellerbe Rd
Shreveport, LA 71106-6724

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision109
Removal of tissue1-10
Removal of skin lesions2006
Removal of nail tissue1-10
Removal or shaving of skin growth95
Skin biopsy95

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014569LAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology and Skin Surgery Apmc Dermatology CurrentSince Jan 2, 2008 Accepting new patients

Locations

845 Olive St
Shreveport, LA 71104
Phone (318) 222-3278

9007 Ellerbe Rd
Shreveport, LA 71106
Phone (318) 222-3278

Interoperability endpoints

  • Direct secure messaging: dclemons@dermatologyskinsurgery.emadirect.md

Organizations & group practices 1

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 4

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": "1133222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1306829916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 OLIVE ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042101",
            "telephone_number": "318-222-3278",
            "fax_number": "318-421-3155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 OLIVE ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042101",
            "telephone_number": "318-222-3278",
            "fax_number": "318-421-3155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMONS",
        "first_name": "DAVID",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-29",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "LA",
            "license": "014569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1318680",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.