NPIMap

Individual provider Active NPI

Johnny Kevin Ingram, M.D.

  • Family Medicine Physician
  • Vidalia, LA
National Provider Identifier
1437100419
Registry record updated Feb 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD200671 Issued in LA
Practice address
1154 Logan Sewell Dr
Vidalia, LA 71373-3342
Phone
(318) 336-8166
Fax
(318) 336-8169
NPI assigned
May 13, 2006
Last updated
Feb 10, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD200671 LA Primary

Addresses

Primary practice location

1154 Logan Sewell Dr
Vidalia, LA 71373-3342

Mailing address

1154 Logan Sewell Dr
Vidalia, LA 71373-3342
Phone (318) 336-8166

Other identifiers 1

IdentifierTypeStateIssuer
1066435MedicaidIA

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
I20060621000168 LA Practitioner - Family PracticePractitioner - General Practice 3678585387 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: General Practice
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1154 Logan Sewell Dr
Vidalia, LA 71373-3342
Phone (318) 336-8166

6569 Hwy 84
Ferriday, LA 71334-4573
Phone 3187576551605

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.94 of 100Reported as group
Quality
88.02
Improvement activities
40
Cost
53.7

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD200671LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Concordia Parish Hospital Service District Number One Family Medicine Current Accepting new patients
J Kevin Ingram Medical, Inc Family Medicine CurrentSince May 30, 2006 Accepting new patients
Concordia Parish Hospital Service District Number One Family Medicine Current Accepting new patients
Concordia Nursing Home Inc Past Accepting new patients
Total Urgent Care and Occupational Medicine PastSince May 1, 2020 Accepting new patients
Camellia Hospice of East Louisiana, LLC Family Medicine Past Accepting new patients
Columns SNF Operations LLC Past Accepting new patients

Locations

204 Serio Blvd
Ferriday, LA 71334
Phone (318) 757-0210

6569 Highway 84
Ridgecrest, LA 71334
Phone 3187576551605

1154 Logan Sewell Dr
Vidalia, LA 71373
Phone (318) 336-8166

1806 Carter St
Vidalia, LA 71373
Phone (318) 336-7172

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Camelot Leisure LivingFerriday, LA, CCN 195516 Skilled nursing facility Adp of the SNF Jan 15, 2015

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391990400000",
    "number": "1437100419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1154 LOGAN SEWELL DR",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733342",
            "telephone_number": "318-336-8166",
            "fax_number": "318-336-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1154 LOGAN SEWELL DR",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733342",
            "telephone_number": "318-336-8166",
            "fax_number": "318-336-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "INGRAM",
        "first_name": "JOHNNY",
        "middle_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2014-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD200671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1066435",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, LA

Sources for this page

Verify at the official NPI Registry.