NPIMap

Organization Active NPI

Seaside Health System, LLC

  • Psychiatry Physician
  • Baton Rouge, LA
National Provider Identifier
1639547243
Registry record updated May 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2203781725 Issued in LA
Legal business name
SEASIDE HEALTH SYSTEM, LLC
Practice address
4363 Convention Street
Baton Rouge, LA 70806
Phone
(225) 522-4076
Fax
(225) 448-2733
NPI assigned
Sep 14, 2015
Organization subpart
Yes
Parent organization
SEASIDE HEALTH SYSTEMS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 7, 2024

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

Authorized official

Name
Christina Ryan
Title
Business Office Manager
Phone
(337) 345-5110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 2203781725 LA Primary

Addresses

Primary practice location

4363 Convention Street
Baton Rouge, LA 70806

Mailing address

425 Ashley Ridge Blvd
Shereport, LA 71106
Phone (318) 841-2619

Other identifiers 2

IdentifierTypeStateIssuer
2700081MedicaidLA
2432559MedicaidLA

Other names 1

  • SHS Physician Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150519000098 LA Part B Supplier - Clinic/Group Practice 6800926429 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA; Zachary, LA

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Seaside Health System LLC2 organizations share this tax ID, including this one
Part of
Seaside Health System LLC

Other organizations with this tax ID 1

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

Locations

425 Ashley Ridge Blvd
Shreveport, LA 71106
Phone (318) 797-3311

425 Ashley Ridge Blvd
Ste 340
Shreveport, LA 71106

1418 Tiger Dr
Thibodaux, LA 70301
Phone (985) 449-4055

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1442188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715040000000",
    "number": "1639547243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ASHLEY RIDGE BLVD",
            "city": "SHEREPORT",
            "state": "LA",
            "postal_code": "71106",
            "telephone_number": "318-841-2619",
            "fax_number": "318-841-2611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4363 CONVENTION STREET",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70806",
            "telephone_number": "225-522-4076",
            "fax_number": "225-448-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE HEALTH SYSTEM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SEASIDE HEALTH SYSTEMS, LLC",
        "enumeration_date": "2015-09-14",
        "last_updated": "2024-05-07",
        "certification_date": "2024-05-07",
        "status": "A",
        "authorized_official_last_name": "RYAN",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "337-345-5110"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "LA",
            "license": "2203781725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2700081",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2432559",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHS Physician Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2024; 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.