NPIMap

Organization Active NPI

Affinity Health Group LLC

Doing business as Affinity Urology Clinic2

  • Urology Physician
  • Monroe, LA
National Provider Identifier
1609366053
Registry record updated Jul 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
AFFINITY HEALTH GROUP LLC
Doing business as
Affinity Urology Clinic2
Practice address
2516 Broadmoor Blvd Ste 3C1
Monroe, LA 71201-2988
Phone
(318) 807-4743
Fax
(318) 361-2180
NPI assigned
May 11, 2018
Last updated
Jul 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2021

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

Authorized official

Name
Janet L Justice
Title
Director of Operations
Phone
(318) 998-3426

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

2516 Broadmoor Blvd Ste 3C1
Monroe, LA 71201-2988

Mailing address

130 Desiard St Ste 355
Monroe, LA 71201-7363
Phone (318) 807-7875

Other names 1

  • Affinity Urology Clinic2 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080411000088 LA Part B Supplier - Clinic/Group Practice 9335226547 Receives reassigned benefits from 165 practitioners
38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monroe, LA; West Monroe, LA; Baton Rouge, LA

Other NPIs on the same Medicare enrollment 31

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

View all 31

National Provider Directory

National Provider Directory
Tax ID family
Affinity Walk in Clinic27 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

Locations

2516 Broadmoor Blvd
Ste 3C1
Monroe, LA 71201
Phone (318) 807-4743

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1525996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626825600000",
    "number": "1609366053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST STE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017363",
            "telephone_number": "318-807-7875",
            "fax_number": "318-812-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 BROADMOOR BLVD STE 3C1",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712012988",
            "telephone_number": "318-807-4743",
            "fax_number": "318-361-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINITY HEALTH GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-11",
        "last_updated": "2021-07-21",
        "certification_date": "2021-07-21",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "318-998-3426"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Affinity Urology Clinic2",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Affinity Urology Clinic2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2021; 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.