Individual provider Active NPI

Ronald John Kluchin, MD

  • Internal Medicine Physician
  • Mandeville, LA
National Provider Identifier
1679565899
Registry record updated Mar 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
017699 Issued in LA
Practice address
784 Asbury Dr
Mandeville, LA 70471-1844
Phone
(985) 626-8110
Fax
(985) 626-8423
NPI assigned
Aug 16, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 017699 LA Primary

Addresses

Primary practice location

784 Asbury Dr
Mandeville, LA 70471-1844

Mailing address

784 Asbury Dr
Mandeville, LA 70471-1844
Phone (985) 626-8110

Other identifiers 1

IdentifierTypeStateIssuer
1386057MedicaidLA

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
I20040315001130 LA Practitioner - Internal Medicine 0547159584 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
017699LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC Current Accepting new patients
Ochsner Clinic LLC CurrentSince Mar 1, 2017 Accepting new patients
Ochsner Clinic LLC Internal Medicine CurrentSince Mar 1, 2017 Accepting new patients

Locations

2810 E Causeway Approach
Mandeville, LA 70448
Phone (985) 674-9400

1514 Jefferson Hwy
New Orleans, LA 70121

104 Acadia Park Dr
#9390
Raceland, LA 70394
Phone (225) 336-3100

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

Organizations & group practices 3

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": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395619200000",
    "number": "1679565899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "784 ASBURY DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704711844",
            "telephone_number": "985-626-8110",
            "fax_number": "985-626-8423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "784 ASBURY DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704711844",
            "telephone_number": "985-626-8110",
            "fax_number": "985-626-8423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLUCHIN",
        "first_name": "RONALD",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2014-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "017699",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1386057",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandeville, LA

Sources for this page

Verify at the official NPI Registry.