Active NPI
Brent Boudreaux, MD
- Diagnostic Radiology Physician
- Shreveport, LA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- 017805
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1347264 | Medicaid | LA |
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
Enrollment records 1
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
Practice addresses (Care Compare)
2600 Greenwood Rd
Shreveport, LA 71103-3908
Phone (318) 212-4550
Hospital & facility affiliations
- Willis Knighton Medical Center
- North Caddo Medical Center
- Minden Medical Center
- Christus Shreveport-Bossier Health System
- Ochsner Lsu Health Shreveport
Merit-based Incentive Payment System (MIPS)
- Final score
- 91.94 of 100
- Quality
- 100
- Improvement activities
- 40
- Cost
- 73.13
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17805 | LA | MD | Pharmacist |
| 017805 | LA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Red River Consultants, Inc | Diagnostic Radiology | Current | 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.
-
- Diagnostic Radiology Physician
- Shreveport, LA
- NPI 1902877426
Hospital & facility affiliations 8
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Shreveport, LA
- NPI 1417950106
-
- Rural Acute Care Hospital
- Minden, LA
- NPI 1891873337
-
- Critical Access Hospital
- Vivian, LA
- NPI 1326016684
-
- General Acute Care Hospital
- Shreveport, LA
- NPI 1427536325
-
- General Acute Care Hospital
- Bossier City, LA
- NPI 1003968579
-
- General Acute Care Hospital
- Shreveport, LA
- NPI 1124170691
-
- General Acute Care Hospital
- Shreveport, LA
- NPI 1275685539
-
- General Acute Care Hospital
- Shreveport, LA
- NPI 1568461572
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.