NPIMap

Organization Active NPI

Jefferson Anesthesia Consultants

  • Anesthesiology Physician
  • Kenner, LA
National Provider Identifier
1639816374
Registry record updated Aug 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
JEFFERSON ANESTHESIA CONSULTANTS
Practice address
2816 Kingston St Ste C
Kenner, LA 70062-4995
Phone
(504) 408-0804
NPI assigned
May 15, 2022
Last updated
Aug 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2022

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

Authorized official

Name
Grant Gillen, MDNPI 1346256096
Title
Member
Phone
(504) 408-0804

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

2816 Kingston St Ste C
Kenner, LA 70062-4995

Mailing address

2816 Kingston St Ste C
Kenner, LA 70062-4995
Phone (504) 408-0804

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220803003439 LA Part B Supplier - Clinic/Group Practice 8820470057 Receives reassigned benefits from 74 practitioners
Practice locations: Marrero, LA; Metairie, LA; Opelousas, LA

National Provider Directory

National Provider Directory

Locations

2816 Kingston St
Ste C
Kenner, LA 70062
Phone (504) 408-0804

Practitioners & affiliated clinicians

Practitioners 83

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.

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1652572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1639816374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2816 KINGSTON ST STE C",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700624995",
            "telephone_number": "504-408-0804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2816 KINGSTON ST STE C",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "700624995",
            "telephone_number": "504-408-0804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON ANESTHESIA CONSULTANTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-15",
        "last_updated": "2022-08-10",
        "certification_date": "2022-08-10",
        "status": "A",
        "authorized_official_last_name": "GILLEN",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "504-408-0804",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenner, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; 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.