NPIMap

Individual provider Active NPI

Jimmy R Coughran, MD

  • Family Medicine Physician
  • Winnsboro, LA
National Provider Identifier
1568438323
Registry record updated Dec 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
021579 Issued in LA
Practice address
101 Fair Avenue
Winnsboro, LA 71295-2116
Phone
(318) 435-8020
Fax
(318) 435-8099
NPI assigned
Feb 23, 2006
Last updated
Dec 12, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2012

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 021579 LA Primary

Addresses

Primary practice location

101 Fair Avenue
Winnsboro, LA 71295-2116

Mailing address

PO Box 730
Winnsboro, LA 71295-0730
Phone (318) 435-8020

Other identifiers 4

IdentifierTypeStateIssuer
L92023OtherLAVANTAGE PROVIDER
5287021OtherLAAETNA PROVIDER NUMBER
1449130MedicaidLA
1971391MedicaidLA

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
I20050112000000 LA Practitioner - Family Practice 5294783874 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in New Orleans, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Jimmy R Coughran a Medical CorporationGroup PAC ID 2769430347, 6 clinicians

Practice addresses (Care Compare)

1010 Davis Lake Rd
Columbia, LA 71418-4231
Phone (318) 649-3766

Hospital & facility affiliations

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
021579LAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Colvin Medical Corporation Family Medicine Current Accepting new patients
Southern Medical Services of Louisiana, LLC CurrentSince Oct 29, 2018 Accepting new patients
Jimmy R Coughran a Medical Corporation Family Medicine CurrentSince Jul 6, 2004 Accepting new patients

Locations

1523 Texas Ave
Bastrop, LA 71220
Phone (318) 281-0078

510 S Washington St
Bastrop, LA 71220
Phone (318) 556-3333

1010 Davis Lake Rd
Columbia, LA 71418
Phone (318) 435-8020

8950 Highway 165 N
Ste 2
Sterlington, LA 71280
Phone (318) 855-2222

8952 Highway 165 N
Sterlington, LA 71280
Phone (318) 855-2222

101 Fair Ave
Winnsboro, LA 71295
Phone (318) 435-8020

101 Fair Ave
Ste A
Winnsboro, LA 71295

2106 Loop Rd
Ste A
Winnsboro, LA 71295
Phone (318) 435-6363

Organizations & group practices 3

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 10

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": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355270400000",
    "number": "1568438323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 730",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712950730",
            "telephone_number": "318-435-8020",
            "fax_number": "318-435-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 FAIR AVENUE",
            "city": "WINNSBORO",
            "state": "LA",
            "postal_code": "712952116",
            "telephone_number": "318-435-8020",
            "fax_number": "318-435-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUGHRAN",
        "first_name": "JIMMY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2012-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "021579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VANTAGE PROVIDER",
            "identifier": "L92023",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER  NUMBER",
            "identifier": "5287021",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1449130",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1971391",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnsboro, LA

Sources for this page

Verify at the official NPI Registry.