Individual provider Active NPI

Diana Marie Bienvenu, M.D.

  • Pediatrics Physician
  • Shreveport, LA
National Provider Identifier
1326065236
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
014563 Issued in LA
Practice address
1501 Kings Hwy
Department of Pediatrics
Shreveport, LA 71103-4228
Phone
(318) 675-8600
Fax
(318) 675-8638
NPI assigned
Jul 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 014563 LA Primary

Addresses

Primary practice location

1501 Kings Hwy
Department of Pediatrics
Shreveport, LA 71103-4228

Mailing address

1501 Kings Hwy
Department of Pediatrics
Shreveport, LA 71103-4228
Phone (318) 675-8600

Other identifiers 1

IdentifierTypeStateIssuer
1313513MedicaidLA

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
I20100222000729 LA Practitioner - Pediatric Medicine 1052455540 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
14563LAMDSocial Worker
014563LAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lsu Health Sciences Center Shreveport Faculty Group Practice Pediatrics CurrentSince Dec 1, 2016 Accepting new patients

Locations

1501 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0434

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

1512 W Kirby Pl
Shreveport, LA 71103
Phone (318) 626-0177

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250726400000",
    "number": "1326065236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-8600",
            "fax_number": "318-675-8638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 KINGS HWY",
            "address_2": "DEPARTMENT OF PEDIATRICS",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-675-8600",
            "fax_number": "318-675-8638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BIENVENU",
        "first_name": "DIANA",
        "middle_name": "MARIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2009-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "014563",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1313513",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.