NPIMap

Organization Active NPI

Thibodaux Regional Network Development Corporation

Doing business as Thibodaux Regional Radiology

  • Diagnostic Radiology Physician
  • Thibodaux, LA
National Provider Identifier
1467427336
Registry record updated Sep 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION
Doing business as
Thibodaux Regional Radiology
Practice address
602 N Acadia Rd
Radiology Dept.
Thibodaux, LA 70301-4847
Phone
(985) 447-5500
NPI assigned
Feb 22, 2006
Last updated
Sep 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2023

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

Authorized official

Name
Kim Legendre Boudreaux
Title
Director of Contracting
Phone
(985) 493-4907

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary
Vascular & Interventional Radiology Physician 2085R0204X NU

Addresses

Primary practice location

602 N Acadia Rd
Radiology Dept.
Thibodaux, LA 70301-4847

Mailing address

PO Box 5478
Thibodaux, LA 70302-5478
Phone (985) 447-5500

Other practice location 1

726 N Acadia Rd Ste 1500
Thibodaux, LA 70301-5051
Phone (985) 493-4756

Other identifiers 1

IdentifierTypeStateIssuer
1948756MedicaidLA

Other names 1

  • Thibodaux Regional Radiology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608000132 LA Part B Supplier - Clinic/Group Practice 8224011754 Receives reassigned benefits from 181 practitioners
37 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Thibodaux, LA; Vacherie, LA; Houma, LA; Labadieville, LA; Paincourtville, LA; Pierre Part, LA; Raceland, LA

Other NPIs on the same Medicare enrollment 37

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

View all 37

National Provider Directory

National Provider Directory
Tax ID family
Thibodaux Regional Network Development Corporation27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Practitioners & affiliated clinicians

Practitioners 131

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.

View all 131

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693872000000",
    "number": "1467427336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5478",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703025478",
            "telephone_number": "985-447-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N ACADIA RD",
            "address_2": "RADIOLOGY DEPT.",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014847",
            "telephone_number": "985-447-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "726 N Acadia Rd Ste 1500",
            "address_purpose": "LOCATION",
            "city": "Thibodaux",
            "state": "LA",
            "postal_code": "703015051",
            "country_code": "US",
            "telephone_number": "985-493-4756",
            "fax_number": "985-449-2552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THIBODAUX REGIONAL NETWORK DEVELOPMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2023-09-05",
        "certification_date": "2023-09-05",
        "status": "A",
        "authorized_official_last_name": "BOUDREAUX",
        "authorized_official_first_name": "KIM",
        "authorized_official_middle_name": "LEGENDRE",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING",
        "authorized_official_telephone_number": "985-493-4907"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1948756",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thibodaux Regional Radiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thibodaux, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.