Active NPI
Brandon Gage Blackledge, DO
- Surgery Physician
- Shreveport, LA
National Provider Identifier
1376162065
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 352569
- Practice address
- 8001 Youree Dr Ste 960
Shreveport, LA 71115-2355 - Phone
- (318) 212-2746
- Fax
- (318) 212-2759
- NPI assigned
- Apr 13, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 352569 | LA | Primary |
Addresses
Primary practice location
8001 Youree Dr Ste 960
Shreveport, LA 71115-2355
Mailing address
8001 Youree Dr Ste 960
Shreveport, LA 71115-2355
Phone (318) 212-2746
Other practice location 1
2600 Greenwood Rd
Shreveport, LA 71103-3908
Phone (601) 953-7160
Other practice location 2
2500 N State St
Jackson, MS 39216-4500
Phone (601) 984-5101
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210120000355 | MS | Order and Referring Only - General Surgery | 5799198479 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783641600000",
"number": "1376162065",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8001 YOUREE DR STE 960",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711152355",
"telephone_number": "318-212-2746",
"fax_number": "318-212-2759"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8001 YOUREE DR STE 960",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711152355",
"telephone_number": "318-212-2746",
"fax_number": "318-212-2759"
}
],
"practiceLocations": [
{
"address_1": "2600 Greenwood Rd",
"address_purpose": "LOCATION",
"city": "Shreveport",
"state": "LA",
"postal_code": "711033908",
"country_code": "US",
"telephone_number": "601-953-7160",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2500 N State St",
"address_purpose": "LOCATION",
"city": "Jackson",
"state": "MS",
"postal_code": "392164500",
"country_code": "US",
"telephone_number": "601-984-5101",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACKLEDGE",
"first_name": "BRANDON",
"middle_name": "GAGE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-04-13",
"last_updated": "2026-07-10",
"certification_date": "2026-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "LA",
"license": "352569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.