NPIMap

Organization Active NPI

Colon & Rectal Associates PC

  • Colon & Rectal Surgery Physician
  • Shreveport, LA
National Provider Identifier
1699703330
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
Legal business name
COLON & RECTAL ASSOCIATES PC
Practice address
1811 E Bert Kouns Ste 430
Shreveport, LA 71105-5741
Phone
(318) 424-8373
Fax
(318) 424-6477
NPI assigned
Jun 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. W. Reid Grimes, M.D.
Title
Vice President
Phone
(318) 424-8373

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208C00000X LA Primary

Addresses

Primary practice location

1811 E Bert Kouns Ste 430
Shreveport, LA 71105-5741

Mailing address

1811 E Bert Kouns Ste 430
Shreveport, LA 71105-5741
Phone (318) 424-8373

Other identifiers 2

IdentifierTypeStateIssuer
071416401MedicaidTX
1107913MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041215000069 LA Part B Supplier - Clinic/Group Practice 8921065665 Receives reassigned benefits from 3 practitioners
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Locations

1801 Fairfield Ave
Ste 401
Shreveport, LA 71101
Phone (318) 424-8373

1811 E Bert Kouns Industrial Loop
Ste 430
Shreveport, LA 71105
Phone (318) 424-8373

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1699703330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 E BERT KOUNS STE 430",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055741",
            "telephone_number": "318-424-8373",
            "fax_number": "318-424-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 E BERT KOUNS STE 430",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055741",
            "telephone_number": "318-424-8373",
            "fax_number": "318-424-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLON & RECTAL ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "GRIMES",
        "authorized_official_first_name": "W.",
        "authorized_official_middle_name": "REID",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "318-424-8373",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "071416401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1107913",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.