Individual provider Active NPI

Jairo Luis Tejada, M.D

  • Internal Medicine Physician
  • New Orleans, LA
National Provider Identifier
1497108302
Registry record updated Aug 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
328411 Issued in LA
Practice address
4710 S Carrollton Ave
New Orleans, LA 70119-6027
Phone
(504) 454-9020
NPI assigned
Jul 15, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 328411 LA Primary

Addresses

Primary practice location

4710 S Carrollton Ave
New Orleans, LA 70119-6027

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (504) 454-9020

Other practice location 1

1650 Grand Concourse
Bronx, NY 10457-7606
Phone (917) 519-4318

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
I20210817002937 LA Practitioner - Internal Medicine 0941605760 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
PMR la Holding, LLC CurrentSince Aug 10, 2021 Accepting new patients
PMR la Holding, LLC PastSince Nov 9, 2021 Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

4710 S Carrollton Ave
New Orleans, LA 70119
Phone (504) 454-9020

3100 Gentilly Blvd
New Orleans, LA 70122
Phone (504) 383-0599

1070 Westbank Expy
Westwego, LA 70094
Phone (504) 688-2211

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629244800000",
    "number": "1497108302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "504-454-9020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4710 S CARROLLTON AVE",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701196027",
            "telephone_number": "504-454-9020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1650 Grand Concourse",
            "address_purpose": "LOCATION",
            "city": "Bronx",
            "state": "NY",
            "postal_code": "104577606",
            "country_code": "US",
            "telephone_number": "917-519-4318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEJADA",
        "first_name": "JAIRO",
        "middle_name": "LUIS",
        "credential": "M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-15",
        "last_updated": "2021-08-18",
        "certification_date": "2021-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "328411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.