Louisiana State University Health Sciences Center

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

142 Issued in LA

Legal business name

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER

Doing business as

LSU Health Shreveport
LSUHSC-S Clinics

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

Last updated

Nov 17, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

LOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTERAs reported in NPPES

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

Addresses

Other names 2

• LSU Health Shreveport Doing business as
• LSUHSC-S Clinics Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Louisiana State University Health Sciences Center

  • Clinical Medical Laboratory
  • Shreveport, LA
  • NPI 1336762269

  6103730908

  Same PAC ID

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Louisiana State University Health Sciences Center Shreveport

  dba Louisiana State University Health Sciences Center Shreveport Guide

  • Multi-Specialty Clinic/Center
  • Shreveport, LA
  • NPI 1790720738

  O20031208000275

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Lsu HLTH Sciences Center

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Melissa Aron Gillum, PA

  • Physician Assistant
  • Shreveport, LA
  • NPI 1679587562
  Medicare reassignment NPD
• Amy M Bozeman, PA

  • Physician Assistant
  • Shreveport, LA
  • NPI 1265861058
  Medicare reassignment NPD
• Andree Celeste Breaux, P.A.

  • Physician Assistant
  • Shreveport, LA
  • NPI 1639199672
  Medicare reassignment NPD
• Jonathan D Brewer, PA

  • Medical Physician Assistant
  • Monroe, LA
  • NPI 1043359706
  Medicare reassignment NPD
• James Dwarkanath Cotelingam, M.D,

  • Anatomic Pathology Physician
  • Shreveport, LA
  • NPI 1477571685
  Medicare reassignment NPD
• Shiva Doty, PA-C

  • Medical Physician Assistant
  • Shreveport, LA
  • NPI 1912933110
  Medicare reassignment NPD
• Minh Tam Thien Ho, PA

  • Physician Assistant
  • Shreveport, LA
  • NPI 1700288479
  Medicare reassignment NPD
• Ammoura Mohammed Ibrahim, M.B.CH.B

  • Anatomic Pathology & Clinical Pathology Physician
  • Shreveport, LA
  • NPI 1588195911
  Medicare reassignment NPD
• Michelle Akin Johnson, P.A.

  • Physician Assistant
  • Shreveport, LA
  • NPI 1740213909
  Medicare reassignment NPD
• Emily Blythe Phifer Menefee, PA-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1255680930
  Medicare reassignment NPD
• Amanda Calloway Rutherford, PA-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1518100908
  Medicare reassignment NPD
• Sarah Lirette Sanders, PA

  • Physician Assistant
  • Shreveport, LA
  • NPI 1104012178
  Medicare reassignment NPD

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": [],
    "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"
        }
    ]
}

• Louisiana State University Health Sciences Center (LSUHSC-S Department of Anesthesiology)
• Louisiana State University Health Sciences Center (LSUHSC-S Department of Pathology)
• Louisiana State University Health Sciences Center
• Louisiana State University Health Sciences Center (Allied Health Clinics)
• Louisiana State University Health Sciences Center (Louisiana State University Health Sciences)
• Louisiana State University Health Sciences Center (LSU Shreveport HCL)
• Louisiana State University Health Sciences Center (LSUHSC-S Clinics)
• Louisiana State University Health Sciences Center (LSUHSC-S Department of Anesthesiology)
• Louisiana State University Health Sciences Center (LSUHSC Nephrology Group)
• Louisiana State University Health Sciences Center (Allied Health Clinics)

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal Medicine Physician in Louisiana

• 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.

Verify at the official NPI Registry.