Highland Clinic, a Prof Med Corp

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

HIGHLAND CLINIC, A PROF MED CORP

Practice address

1453 E Bert Koun Loop
#210
Shreveport, LA 71105-6800

Phone

(318) 798-4623

Fax

(318) 798-4646

NPI assigned

Nov 2, 2015

Last updated

Jun 2, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Gustavson

Title

Administrator

Phone

(318) 798-4465

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Highland Clinic, a Prof Med Corp

  • Multi-Specialty Clinic/Center
  • Shreveport, LA
  • NPI 1053315846

  3870493463

  Same PAC ID
• Highland Clinic, a Prof Med Corp

  • Non-Pharmacy Dispensing Site
  • Shreveport, LA
  • NPI 1609297449

  3870493463

  Same PAC ID
• Highland Clinic, a Prof Med Corp

  • Orthopaedic Surgery Physician
  • Bossier City, LA
  • NPI 1740897743

  3870493463

  Same PAC ID

Tax ID family

Highland Clinic Laborat3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Highland Clinic, a Prof Med Corp

  • Non-Pharmacy Dispensing Site
  • Shreveport, LA
  • NPI 1609297449
  NPD tax ID
• Highland Clinic, a Prof Med Corp

  • Orthopaedic Surgery Physician
  • Bossier City, LA
  • NPI 1740897743
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gordon M Mead, MD

  • Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1518961317
  NPD (past)

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

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780358400000",
    "number": "1700259678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 E BERT KOUN LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055634",
            "telephone_number": "318-798-4500",
            "fax_number": "318-798-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1453 E BERT KOUN LOOP",
            "address_2": "#210",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711056800",
            "telephone_number": "318-798-4623",
            "fax_number": "318-798-4646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIGHLAND CLINIC, A PROF MED CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-02",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A",
        "authorized_official_last_name": "GUSTAVSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-798-4465",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1038300",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Highland Clinic Optical Shop, LLC
• Highland Clinic Pharmacy, LLC
• Highland Clinic, a Prof Med Corp
• Highland Clinic, a Prof Med Corp
• Highland Clinic, a Prof Med Corp
• Highland Clinic, a Prof Med Corp
• Highland Emergency Group, LLC
• Highland Wellness Center, LLC
• Julian Hightower, LMT
• Yazan Hijazein

• Orthopaedic Surgery Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Orthopaedic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.