NPIMap

Individual provider Active NPI

Jerome Gallien, M.D.

  • Diagnostic Radiology Physician
  • Jennings, LA
National Provider Identifier
1417941162
Registry record updated Oct 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
016193 Issued in LA
Practice address
1634 Elton Rd
Jennings, LA 70546-3614
Phone
(337) 616-7000
NPI assigned
Sep 8, 2005
Last updated
Oct 8, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 016193 LA Primary

Addresses

Primary practice location

1634 Elton Rd
Jennings, LA 70546-3614

Mailing address

PO Box 1128
Jennings, LA 70546-1128
Phone (337) 824-4403

Other identifiers 1

IdentifierTypeStateIssuer
1913961MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100922000347 LA Practitioner - Diagnostic Radiology 1456317858 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Louisiana State University School of Medicine in Shreveport, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regional Radiology, LLCGroup PAC ID 2860404811, 40 clinicians

Practice addresses (Care Compare)

1202 S Tyler St
Covington, LA 70433-2330
Phone (985) 898-4000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16193LAMDClinical Social Worker
016193LAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regional Radiology, LLC Diagnostic Radiology CurrentSince Oct 1, 2023 Accepting new patients
Teche Diagnostic Imaging Center LLC Past Accepting new patients
Lafayette Health Ventures, Inc Past Accepting new patients
US Radiology Partners of Louisiana, Inc. Diagnostic Radiology Past Accepting new patients
St Tammany Parish Hospital Service District No 1 Past Accepting new patients

Locations

1202 S Tyler St
Covington, LA 70433
Phone (985) 898-3743

16282 Highway 1085
Covington, LA 70433
Phone (985) 898-4140

82525 Highway 25
Folsom, LA 70437
Phone (985) 839-9895

1322 Elton Rd
Ste F
Jennings, LA 70546
Phone (337) 824-8868

1634 Elton Rd
Jennings, LA 70546
Phone (337) 616-7000

1214 Coolidge Blvd
Lafayette, LA 70503
Phone (337) 234-9191

409 W Pont des Mouton Rd
Lafayette, LA 70507

2390 W Congress St
Lafayette, LA 70506
Phone (337) 261-6000

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412726400000",
    "number": "1417941162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1128",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705461128",
            "telephone_number": "337-824-4403",
            "fax_number": "337-824-9731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 ELTON RD",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705463614",
            "telephone_number": "337-616-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLIEN",
        "first_name": "JEROME",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2014-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "016193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1913961",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jennings, LA

Sources for this page

Verify at the official NPI Registry.