Individual provider Active NPI

Amanda E Preedom, M.D.

  • Pediatrics Physician
  • Baton Rouge, LA
National Provider Identifier
1659595502
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0101245041 Issued in VA
Practice address
16777 Medical Center Dr
Baton Rouge, LA 70816-3254
Phone
(225) 754-3278
Fax
(225) 754-3297
NPI assigned
Apr 12, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 0101245041 VA Primary

Addresses

Primary practice location

16777 Medical Center Dr
Baton Rouge, LA 70816-3254

Mailing address

202 8TH St
Radford, VA 24141-2426
Phone (540) 639-5188

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
I20241004002788 LA Practitioner - Pediatric Medicine 0244525186 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101245041VAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC Current Accepting new patients
Ochsner Clinic LLC CurrentSince Aug 19, 2024 Accepting new patients
Ochsner Clinic LLC CurrentSince Aug 19, 2024 Accepting new patients
Child Adolescent Health Associates of the New River Valley PC Pediatrics Past Accepting new patients
Ochsner Clinic LLC Past Accepting new patients
East Baton Rouge Medical Center LLC Past Accepting new patients

Locations

10310 The Grove Blvd
Baton Rouge, LA 70836
Phone (225) 761-5239

16777 Medical Center Dr
Baton Rouge, LA 70816
Phone (225) 754-3278

16777 Medical Center Dr
Ste 200
Baton Rouge, LA 70816
Phone (225) 936-7066

17000 Medical Center Dr
Baton Rouge, LA 70816
Phone (225) 752-2470

1514 Jefferson Hwy
New Orleans, LA 70121

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

Interoperability endpoints

  • Direct secure messaging: apreedom2304319@direct.ochsner.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728518400000",
    "number": "1659595502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 8TH ST",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241412426",
            "telephone_number": "540-639-5188",
            "fax_number": "540-639-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16777 MEDICAL CENTER DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708163254",
            "telephone_number": "225-754-3278",
            "fax_number": "225-754-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREEDOM",
        "first_name": "AMANDA",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101245041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.