Shreveport Internal Medicine and Pediatrics LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SHREVEPORT INTERNAL MEDICINE AND PEDIATRICS LLC

Practice address

10401 E Kings Hwy
Shreveport, LA 71115-3227

Phone

(318) 558-0880

Fax

(318) 562-6354

NPI assigned

Dec 21, 2006

Last updated

Sep 4, 2024By 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

Allan S Matriano Lim, MDNPI 1649268590

Title

Owner

Phone

(318) 588-0880

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 7

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.

• Allan S Matriano Lim, MD

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1649268590
  Medicare reassignment NPD Authorized official
• Kevin Neal Boykin, M.D.

  • Pediatric Surgery Physician
  • Shreveport, LA
  • NPI 1710909163
  NPD (past)
• Mark Frederick Brown, M.D.

  • Pediatric Surgery Physician
  • Shreveport, LA
  • NPI 1689672032
  NPD (past)
• Felicia Annette Croft, ACNPC-AG

  • Acute Care Nurse Practitioner
  • Shreveport, LA
  • NPI 1316785215
  NPD (past)
• Kristi Harrison Gaspard, PA-C

  • Physician Assistant
  • Shreveport, LA
  • NPI 1013499763
  NPD (past)
• Donald Lynn Sorrells Jr., MD

  • Pediatric Surgery Physician
  • Shreveport, LA
  • NPI 1689672172
  NPD (past)
• Ahmed Virani, MD

  • Pulmonary Disease Physician
  • Shreveport, LA
  • NPI 1881081941

  Multi-Specialty

  NPD (past)

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725408000000",
    "number": "1710041900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10401 E KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711153227",
            "telephone_number": "318-588-0880",
            "fax_number": "318-562-6354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10401 E KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711153227",
            "telephone_number": "318-558-0880",
            "fax_number": "318-562-6354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT INTERNAL MEDICINE AND PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A",
        "authorized_official_last_name": "MATRIANO LIM",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-588-0880",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shreveport Eye Specialists, LLC
• Shreveport Family Medicine Inc
• Shreveport Geriatrics
• Shreveport Geriatrics
• Shreveport Health and Wellness (Shreveport Neuropathy)
• Shreveport Internal Medicine, LLC
• Shreveport Manor, LLC
• Shreveport Mental Health
• Shreveport Mental Health Center
• Shreveport Mental Health Center

• Internal Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; 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.