Individual provider Active NPI

Brent Boudreaux, MD

  • Diagnostic Radiology Physician
  • Shreveport, LA
National Provider Identifier
1467423913
Registry record updated Feb 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
017805 Issued in LA
Practice address
2600 Greenwood Rd
Shreveport, LA 71103-3908
Phone
(318) 212-4550
NPI assigned
Jan 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 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 017805 LA Primary

Addresses

Primary practice location

2600 Greenwood Rd
Shreveport, LA 71103-3908

Mailing address

PO Box 9600
Dept 09-033
Texarkana, TX 75505-9600
Phone (877) 243-8416

Other identifiers 1

IdentifierTypeStateIssuer
1347264MedicaidLA

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
I20100726000461 LA Practitioner - Diagnostic Radiology 4082704507 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Louisiana State University School of Medicine in Shreveport, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Red River Consultants IncGroup PAC ID 1355303363, 56 clinicians

Practice addresses (Care Compare)

2600 Greenwood Rd
Shreveport, LA 71103-3908
Phone (318) 212-4550

Hospital & facility affiliations

  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
  • North Caddo Medical Center Hospital, Vivian, LA, CCN 191304
  • Minden Medical Center Hospital, Minden, LA, CCN 190144
  • Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041
  • Ochsner Lsu Health Shreveport Hospital, Shreveport, LA, CCN 190098

Merit-based Incentive Payment System (MIPS)

Final score
91.94 of 100Reported as group
Quality
100
Improvement activities
40
Cost
73.13

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17805LAMDPharmacist
017805LAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Red River Consultants, Inc Diagnostic Radiology CurrentSince Jan 1, 2003 Accepting new patients

Locations

2600 Greenwood Rd
Shreveport, LA 71103
Phone (318) 212-4600

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

2510 Bert Kouns Industrial Loop
Shreveport, LA 71118
Phone (318) 212-5000

Organizations & group practices 1

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 8

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": "1138665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391385600000",
    "number": "1467423913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9600",
            "address_2": "DEPT 09-033",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755059600",
            "telephone_number": "877-243-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 GREENWOOD RD",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711033908",
            "telephone_number": "318-212-4550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "BRENT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-31",
        "last_updated": "2014-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "017805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1347264",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.