J H Fairbanks MD PLLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

MD017268 Issued in LA

Legal business name

J H FAIRBANKS MD PLLC

Practice address

107 Front St
Suite 230
Vidalia, LA 39120

Phone

(318) 336-2212

Fax

(318) 336-6067

NPI assigned

Dec 11, 2006

Last updated

Jul 3, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

J H FAIRBANKS MD PLLCAs reported in NPPES

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

Authorized official

Name

Angel Nicole Nugent

Title

Manager

Phone

(318) 336-2212

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Riverpark Sports Medicine and Physical Therapy Other name

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

Part of

John H Fairbanks MD PLLC

Locations

Practitioners 2

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.

• John H Fairbanks, M.D.

  • Orthopaedic Surgery Physician
  • Vidalia, LA
  • NPI 1669491288
  Medicare reassignment Care Compare group NPD
• Michael R Wimberly II, PT,MPT

  • Physical Therapist
  • Vidalia, LA
  • NPI 1700937950
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688342400000",
    "number": "1336209550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "address_2": "SUITE 230",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "39120",
            "telephone_number": "318-336-2212",
            "fax_number": "318-336-6067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "address_2": "SUITE 230",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "39120",
            "telephone_number": "318-336-2212",
            "fax_number": "318-336-6067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J H FAIRBANKS MD PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "J H FAIRBANKS MD PLLC",
        "enumeration_date": "2006-12-11",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A",
        "authorized_official_last_name": "NUGENT",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "318-336-2212"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MS",
            "license": "15703",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "LA",
            "license": "MD017268",
            "primary": true
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "LA",
            "license": "MD017268",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1384101",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00119142",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverpark Sports Medicine and Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Johnny Kevin Ingram, M.D.
• Intensive Home Healthcare, Inc
• Intensive Home Healthcare, Inc. (Intensive Home Healthcare and Hospice of Louisiana)
• Lashaun Ivory
• J Kevin Ingram Medical, Inc
• Amber Jackson
• Ashley Jackson
• Kristie Jackson
• Valerie Jackson

• Orthopaedic Surgery Physician in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Orthopaedic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; 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.