Individual provider Active NPI

Son Binh Nguyen, M.D.

  • Family Medicine Physician
  • Gretna, LA
National Provider Identifier
1710121348
Registry record updated Dec 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD.205430 Issued in LA
Practice address
435 Lapalco Blvd
Suite 1
Gretna, LA 70056-7369
Phone
(504) 392-4114
Fax
(504) 533-8622
NPI assigned
Apr 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD.205430 LA Primary

Addresses

Primary practice location

435 Lapalco Blvd
Suite 1
Gretna, LA 70056-7369

Mailing address

435 Lapalco Blvd
Suite 1
Gretna, LA 70056-7369
Phone (504) 392-4114

Other identifiers 2

IdentifierTypeStateIssuer
1883964MedicaidLA
06735723MedicaidMS

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
I20120830000368 LA Practitioner - Family Practice 1254588072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

435 Lapalco Blvd
Suite 1
Gretna, LA 70056-7375
Phone (504) 392-4114

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.205430LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Medical Clinic LLC Family Medicine CurrentSince Sep 16, 2013 Accepting new patients

Locations

435 Lapalco Blvd
Ste 1
Gretna, LA 70056
Phone (504) 392-4114

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1710121348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 LAPALCO BLVD",
            "address_2": "SUITE 1",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700567369",
            "telephone_number": "504-392-4114",
            "fax_number": "504-533-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 LAPALCO BLVD",
            "address_2": "SUITE 1",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700567369",
            "telephone_number": "504-392-4114",
            "fax_number": "504-533-8622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "SON",
        "middle_name": "BINH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-27",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.205430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1883964",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "06735723",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gretna, LA

Sources for this page

Verify at the official NPI Registry.