Bluefin Medical, LLC

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

Legal business name

BLUEFIN MEDICAL, LLC

Practice address

850 Margaret PL
Shreveport, LA 71101-4521

Phone

(318) 208-2000

Fax

(318) 227-7627

NPI assigned

Dec 1, 2022

Organization subpart

Yes

Parent organization

BLUE MEDICAL, LLCAs reported in NPPES

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

Authorized official

Name

Dr. Randall Ivan Davis, MDNPI 1942270293

Title

Ceo

Phone

(318) 773-5880

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• BlueFin Recovery Doing business as

Part of

Bluefin Medical LLC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randall I Davis, MD

  • Emergency Medicine Physician
  • Shreveport, LA
  • NPI 1942270293
  NPD Authorized official

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

{
    "created_epoch": "1669852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669852800000",
    "number": "1376253138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 MARGARET PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014521",
            "telephone_number": "318-208-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 MARGARET PL",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014521",
            "telephone_number": "318-208-2000",
            "fax_number": "318-227-7627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEFIN MEDICAL, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLUE MEDICAL, LLC",
        "enumeration_date": "2022-12-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "IVAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "318-773-5880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1486647",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BlueFin Recovery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Addiction Medicine (Family Medicine) Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Addiction Medicine (Family Medicine) Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.