Individual provider Active NPI

Pavan Katikaneni, MD

  • Interventional Cardiology Physician
  • Shreveport, LA
National Provider Identifier
1568639730
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
MD.204680 Issued in LA
Practice address
1453 E Bert Koun Loop Ste 112
Shreveport, LA 71105-6810
Phone
(318) 798-9400
Fax
(318) 795-4656
NPI assigned
May 15, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD.204680 LA
Cardiovascular Disease Physician 207RC0000X MD.204680 LA
Interventional Cardiology Physician 207RI0011X MD.204680 LA Primary

Addresses

Primary practice location

1453 E Bert Koun Loop Ste 112
Shreveport, LA 71105-6810

Mailing address

PO Box 51008
Shreveport, LA 71135-1008
Phone (318) 798-9400

Other identifiers 1

IdentifierTypeStateIssuer
05962MedicaidLA

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
I20121210000498 LA Practitioner - Interventional CardiologyPractitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 5799937140 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional CardiologyAlso: Cardiovascular Disease (Cardiology)
Education
University of Massachusetts Medical School, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Cardiovascular SpecialistsGroup PAC ID 7315224755, 21 clinicians

Practice addresses (Care Compare)

1453 E Bert Koun Loop
Suite 112
Shreveport, LA 71105-6810
Phone (318) 798-9400

Hospital & facility affiliations

  • Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041
  • Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting27

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.204680LAMDInterventional Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lsu Health Sciences Center Shreveport Faculty Group Practice Internal Medicine CurrentSince Jan 1, 2017 Accepting new patients
Advanced Cardiovascular Specialists Cardiovascular Disease CurrentSince Jul 5, 2021 Accepting new patients
Ark-la-Tex Cardiology, Apmc Cardiovascular Disease CurrentSince Sep 4, 2022 Accepting new patients

Locations

1501 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0434

1453 E Bert Kouns Industrial Loop
Ste 112
Shreveport, LA 71105
Phone (318) 798-9400

1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402

1541 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0287

Interoperability endpoints

  • Direct secure messaging: pavan.katikaneni.p1@direct.acs.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: pkatikaneni726039@direct.ochsner.org

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 and National Provider Directory roles.

Hospital & facility affiliations 5

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": "1210809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1568639730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51008",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711351008",
            "telephone_number": "318-798-9400",
            "fax_number": "318-795-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1453 E BERT KOUN LOOP STE 112",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711056810",
            "telephone_number": "318-798-9400",
            "fax_number": "318-795-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KATIKANENI",
        "first_name": "PAVAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-15",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD.204680",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": "MD.204680",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "LA",
            "license": "MD.204680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05962",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.