Individual provider Active NPI

Andrew Jao O'Young, MD

  • Internal Medicine Physician
  • Shreveport, LA
National Provider Identifier
1407884067
Registry record updated Oct 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
13658R Issued in LA
Practice address
2508 Bert Kouns Industrial Loop
Suite 105
Shreveport, LA 71118-3133
Phone
(318) 686-8808
Fax
(318) 212-5018
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 13658R LA Primary

Addresses

Primary practice location

2508 Bert Kouns Industrial Loop
Suite 105
Shreveport, LA 71118-3133

Mailing address

2508 Bert Kouns Industrial Loop
Suite 105
Shreveport, LA 71118-3133
Phone (318) 686-8808

Other identifiers 1

IdentifierTypeStateIssuer
1433128MedicaidLA

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071219000734 LA Practitioner - Internal Medicine 5092805689 Reassigns benefits to 2 organizations
Practice locations: Shreveport, LA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Northwestern University Feinberg Medical School, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Pierremont HospitalistsGroup PAC ID 4082669015, 24 clinicians

Practice addresses (Care Compare)

8001 Youree Dr
Suite 4007
Shreveport, LA 71115-2302
Phone (318) 212-3821

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13658RLAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Shreveport Internal Medicine Internal Medicine CurrentSince Jan 1, 2007 Accepting new patients
WK Pierremont Hospitalists CurrentSince Jul 1, 2022 Accepting new patients
Willis Knighton Medical Center, Inc. Past Accepting new patients

Locations

8001 Youree Dr
Shreveport, LA 71115
Phone (318) 212-3000

2508 Bert Kouns Industrial Loop
Ste 301
Shreveport, LA 71118
Phone (318) 212-5991

8001 Youree Dr
Ste 4007
Shreveport, LA 71115
Phone (318) 212-3821

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286150400000",
    "number": "1407884067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 105",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-686-8808",
            "fax_number": "318-212-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 BERT KOUNS INDUSTRIAL LOOP",
            "address_2": "SUITE 105",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183133",
            "telephone_number": "318-686-8808",
            "fax_number": "318-212-5018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'YOUNG",
        "first_name": "ANDREW",
        "middle_name": "JAO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2010-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "13658R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1433128",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.