NPIMap

Individual provider Active NPI

Jimmy Nolan Ponder Jr., MD

  • Interventional Pain Medicine Physician
  • Gray, LA
National Provider Identifier
1689644874
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
020658 Issued in LA
Practice address
123 Frontage a Rd
Gray, LA 70359-6301
Phone
(985) 580-1200
Fax
(985) 580-1218
NPI assigned
Jan 23, 2006
Last updated
Jul 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 020658 LA Primary

Addresses

Primary practice location

123 Frontage a Rd
Gray, LA 70359-6301

Mailing address

123 Frontage a Rd
Gray, LA 70359-6301
Phone (985) 580-1200

Other identifiers 1

IdentifierTypeStateIssuer
1903680MedicaidLA

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
I20040701000952 LA Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 8325025935 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Pain ManagementAlso: Anesthesiology
Education
Louisiana State University School of Medicine in New Orleans, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

123 Frontage Rd a
Gray, LA 70359-6301
Phone (985) 580-1200

531 A Jefferson Ter
New Iberia, LA 70560-4949
Phone (337) 560-0880

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
020658LAMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Headache & Pain Center, a Medical Corporation Interventional Pain Medicine CurrentSince Nov 1, 2005 Accepting new patients
Advanced Anesthesia Services, LLC Anesthesiology CurrentSince Jun 10, 2005 Accepting new patients
Headache & Pain Center, a Medical Corporation CurrentSince Jul 10, 1995 Accepting new patients
Day Surgery, Inc. PastSince Jan 2, 1999 Accepting new patients

Locations

123 Frontage Road a
Gray, LA 70359
Phone (985) 580-1200

149 Frontage Road a
Gray, LA 70359
Phone (985) 580-1200

Organizations & group practices 4

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 6

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": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278547200000",
    "number": "1689644874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 FRONTAGE A RD",
            "city": "GRAY",
            "state": "LA",
            "postal_code": "703596301",
            "telephone_number": "985-580-1200",
            "fax_number": "985-580-1218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 FRONTAGE A RD",
            "city": "GRAY",
            "state": "LA",
            "postal_code": "703596301",
            "telephone_number": "985-580-1200",
            "fax_number": "985-580-1218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONDER",
        "first_name": "JIMMY",
        "middle_name": "NOLAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2010-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "LA",
            "license": "020658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1903680",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gray, LA

Sources for this page

Verify at the official NPI Registry.