Individual provider Active NPI

Stephen Eugene Ertz, DPM

  • Podiatrist
  • Shreveport, LA
National Provider Identifier
1356321681
Registry record updated Aug 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
PD121R Issued in LA
Practice address
9308 Mansfield Rd
Ste. 100
Shreveport, LA 71118-3134
Phone
(318) 687-6266
Fax
(318) 683-1023
NPI assigned
Jan 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X PD121R LA Primary

Addresses

Primary practice location

9308 Mansfield Rd
Ste. 100
Shreveport, LA 71118-3134

Mailing address

9308 Mansfield Rd
Ste. 100
Shreveport, LA 71118-3134
Phone (318) 687-6266

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120105000973 LA Practitioner - Podiatry 4880638220 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
William M. Scholl College of Podiatric Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1521 Doctors Dr
Bossier City, LA 71111-3321
Phone (318) 747-5200

9308 Mansfield Rd
Suite 100
Shreveport, LA 71118-3134
Phone (318) 687-6266

9308 Mansfield Rd
Suite 100
Shreveport, LA 71118-3177

Merit-based Incentive Payment System (MIPS)

Final score
78.23 of 100Reported as group
Quality
51.97
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue68
Removal of skin lesions14
Removal of nail tissue265
Removal or shaving of skin growth257

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
121LAMDMarriage & Family Therapist
PD121RLAMDPodiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southside Foot Clinic of Shreveport, Inc. a Professional Corporation Podiatrist CurrentSince Nov 6, 1991 Accepting new patients
Southside Foot Clinic of Shreveport Inc a Professional Corporation CurrentSince Nov 6, 1991 Accepting new patients

Locations

1521 Doctors Dr
Bossier City, LA 71111
Phone (318) 747-5200

9308 Mansfield Rd
Ste 100
Shreveport, LA 71118
Phone (318) 686-9622

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280966400000",
    "number": "1356321681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9308 MANSFIELD RD",
            "address_2": "STE. 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183134",
            "telephone_number": "318-687-6266",
            "fax_number": "318-683-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9308 MANSFIELD RD",
            "address_2": "STE. 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183134",
            "telephone_number": "318-687-6266",
            "fax_number": "318-683-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERTZ",
        "first_name": "STEPHEN",
        "middle_name": "EUGENE",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-20",
        "last_updated": "2010-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "LA",
            "license": "PD121R",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.