NPIMap

Individual provider Active NPI

Allen W. Vander, M.D.

  • Nephrology Physician
  • Thibodaux, LA
National Provider Identifier
1669473054
Registry record updated Sep 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
24441 Issued in LA
Practice address
604 N. Acadia Rd
Suite 405
Thibodaux, LA 70301
Phone
(985) 446-0871
Fax
(985) 446-0874
NPI assigned
Aug 9, 2005
Last updated
Sep 25, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 24441 LA Primary

Addresses

Primary practice location

604 N. Acadia Rd
Suite 405
Thibodaux, LA 70301

Mailing address

604 N. Acadia Rd.
Suite 405
Thibodaux, LA 70301
Phone (985) 446-0871

Other identifiers 2

IdentifierTypeStateIssuer
1570796MedicaidLA
7394444OtherAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101022000830 LA Practitioner - Nephrology 6709844368 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Louisiana State University School of Medicine in New Orleans, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kidney Center of South Louisiana, AMCGroup PAC ID 8820042757, 3 clinicians

Practice addresses (Care Compare)

604 N Acadia Rd
Suite 405
Thibodaux, LA 70301-4897
Phone (985) 446-0871

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.07 of 100Reported as individual
Quality
89.65
Promoting interoperability
91
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
024441LAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Center of South Louisiana, AMC Nephrology CurrentSince Jul 1, 2003 Accepting new patients
Thibodaux Regional Health System Inc Past Accepting new patients

Locations

604 N Acadia Rd
Ste 405
Thibodaux, LA 70301
Phone (985) 446-0871

Interoperability endpoints

  • Direct secure messaging: allen.vander@kcosla.eclinicaldirectplus.com
  • Direct secure messaging: avander408153@direct.ochsner.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/EFEIBA

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1253836800000",
    "number": "1669473054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 N. ACADIA RD.",
            "address_2": "SUITE 405",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "70301",
            "telephone_number": "985-446-0871",
            "fax_number": "985-446-0874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 N. ACADIA RD",
            "address_2": "SUITE 405",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "70301",
            "telephone_number": "985-446-0871",
            "fax_number": "985-446-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER",
        "first_name": "ALLEN",
        "middle_name": "W.",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2009-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "24441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1570796",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7394444",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thibodaux, LA

Sources for this page

Verify at the official NPI Registry.