Active NPI
Louisiana State University Health Sciences Center
- Internal Medicine Physician
- Shreveport, LA
National Provider Identifier
1417992249
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 142
- Legal business name
- LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
- Practice address
- 1501 Kings Hwy
Lsuhsc-S Clinics
Shreveport, LA 71103-4228 - Phone
- (318) 675-7737
- Fax
- (318) 675-5666
- NPI assigned
- Jun 17, 2006
- Organization subpart
- Yes
- Parent organization
- LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Leisa P Oglesby
- Title
- Executive Director for Medical Serv
- Phone
- (318) 675-7629
Specialties & licenses 15
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) | 204E00000X | 142 | LA | |
| Allergy & Immunology Physician | 207K00000X | 142 | LA | |
| Dermatology Physician | 207N00000X | 142 | LA | |
| Emergency Medicine Physician | 207P00000X | 142 | LA | |
| Family Medicine Physician | 207Q00000X | 142 | LA | |
| Internal Medicine Physician | 207R00000X | 142 | LA | Primary |
| Nuclear Medicine Physician | 207U00000X | 142 | LA | |
| Obstetrics & Gynecology Physician | 207V00000X | 142 | LA | |
| Ophthalmology Physician | 207W00000X | 142 | LA | |
| Orthopaedic Surgery Physician | 207X00000X | 142 | LA | |
| Otolaryngology Physician | 207Y00000X | 142 | LA | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 142 | LA | |
| Pediatrics Physician | 208000000X | 142 | LA | |
| Psychiatry Physician | 2084P0800X | 142 | LA | |
| Diagnostic Radiology Physician | 2085R0202X | 142 | LA |
Addresses
Primary practice location
1501 Kings Hwy
Lsuhsc-S Clinics
Shreveport, LA 71103-4228
Mailing address
1501 Kings Hwy
Lsuhsc-S Clinics
Shreveport, LA 71103-4228
Phone (318) 675-7737
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1157881 | Medicaid | LA |
Other names 2
- LSU Health Shreveport
- LSUHSC-S Clinics
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031208000275 | LA | Part B Supplier - Clinic/Group Practice | 6103730908 |
Receives reassigned benefits from 24 practitioners 1 other NPI on this enrollment Practice locations: Shreveport, LA |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Clinical Medical Laboratory
- Shreveport, LA
- NPI 1336762269
6103730908
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Multi-Specialty Clinic/Center
- Shreveport, LA
- NPI 1790720738
O20031208000275
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D2168467 | Ochsner Lsu Health Shreveport, Comp Care Building | Provider-performed microscopy | Jun 30, 2027 |
National Provider Directory
National Provider Directory- Part of
- Lsu HLTH Sciences Ctr
Practitioners & affiliated clinicians
Practitioners 26
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Anatomic Pathology & Clinical Pathology Physician
- Shreveport, LA
- NPI 1588195911
Anatomic Pathology & Clinical Pathology, LA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1668643200000",
"number": "1417992249",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"address_2": "LSUHSC-S CLINICS",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-675-7737",
"fax_number": "318-675-5666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 KINGS HWY",
"address_2": "LSUHSC-S CLINICS",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711034228",
"telephone_number": "318-675-7737",
"fax_number": "318-675-5666"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER",
"enumeration_date": "2006-06-17",
"last_updated": "2022-11-17",
"certification_date": "2022-11-17",
"status": "A",
"authorized_official_last_name": "OGLESBY",
"authorized_official_first_name": "LEISA",
"authorized_official_middle_name": "P",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR FOR MEDICAL SERV",
"authorized_official_telephone_number": "318-675-7629"
},
"taxonomies": [
{
"code": "204E00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Oral & Maxillofacial Surgery",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207K00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Allergy & Immunology",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "LA",
"license": "142",
"primary": true
},
{
"code": "207U00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nuclear Medicine",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207Y00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Otolaryngology",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "LA",
"license": "142",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Radiology, Diagnostic Radiology",
"state": "LA",
"license": "142",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1157881",
"state": "LA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "LSU Health Shreveport",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "LSUHSC-S Clinics",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "LSUHSC-S Clinics",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Shreveport, LA
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
- Louisiana State University Health Sciences Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.