NPIMap

Individual provider Active NPI

Shanthi Potla

  • Family Medicine Physician
  • Alexandria, LA
National Provider Identifier
1326736703
Registry record updated Jun 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
346368 Issued in LA
Practice address
807 Jackson St
Alexandria, LA 71301-7656
Phone
(318) 441-1034
NPI assigned
Apr 25, 2023
Last updated
Jun 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2025

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

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medicine Physician 207P00000X 0101283962 VA
Emergency Medicine Physician 207P00000X 346368 LA
Family Medicine Physician 207Q00000X 0101283962 VA
Family Medicine Physician 207Q00000X 346368 LA Primary
Pediatrics Physician 208000000X 0101283962 VA
Pediatrics Physician 208000000X 346368 LA
Psychiatry Physician 2084P0800X 0101283962 VA
Psychiatry Physician 2084P0800X 346368 LA
General Practice Physician 208D00000X 0101283962 VA

Addresses

Primary practice location

807 Jackson St
Alexandria, LA 71301-7656

Mailing address

4043 Starlight Creek Dr
Celina, TX 75009-1597
Phone (858) 699-5499

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250717003861 LA Practitioner - Family Practice 6406362433 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jena Ess LLCGroup PAC ID 7810116258, 15 clinicians
Concord Medical Group PLLCGroup PAC ID 0446296818, 189 clinicians

Practice addresses (Care Compare)

187 9TH St
Jena, LA 71342-3900
Phone (318) 992-9200

2001 Doctors Dr
Springhill, LA 71075-4526
Phone (318) 539-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
346368LAMDEmergency Medicine Physician
0101283962VAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Medical Group PLLC Emergency Medicine CurrentSince May 1, 2025 Accepting new patients
Jena Ess Hospitalist LLC CurrentSince Nov 20, 2025 Accepting new patients
Jena Ess LLC Emergency Medicine CurrentSince Nov 20, 2025 Accepting new patients
Concord Medical Group of Texas PLLC Emergency Medicine CurrentSince May 1, 2025 Accepting new patients
Indus Health Pro Family Medicine CurrentSince Jun 15, 2025 Accepting new patients

Locations

600 S Pine St
Deridder, LA 70634
Phone (337) 462-7100

187 Ninth St
Jena, LA 71342
Phone (318) 992-9200

2001 Doctors Dr
Springhill, LA 71075
Phone (318) 539-1000

Organizations & group practices 7

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 11

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": "1682380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1326736703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4043 STARLIGHT CREEK DR",
            "city": "CELINA",
            "state": "TX",
            "postal_code": "750091597",
            "telephone_number": "858-699-5499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 JACKSON ST",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713017656",
            "telephone_number": "318-441-1034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POTLA",
        "first_name": "SHANTHI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-04-25",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "VA",
            "license": "0101283962",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "346368",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101283962",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "346368",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101283962",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "346368",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101283962",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "346368",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101283962",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

Verify at the official NPI Registry.