Individual provider Active NPI

Timothy E Mathis, MD

  • Family Medicine Physician
  • Shreveport, LA
National Provider Identifier
1730185927
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
07536R Issued in LA
Practice address
8383 Millicent Way
Shreveport, LA 71115-5207
Phone
(318) 797-6661
Fax
(318) 795-8512
NPI assigned
Jun 22, 2005
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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 07536R LA Primary

Addresses

Primary practice location

8383 Millicent Way
Shreveport, LA 71115-5207

Mailing address

8383 Millicent Way
Shreveport, LA 71115-5207
Phone (318) 797-6661

Other identifiers 5

IdentifierTypeStateIssuer
5843480OtherLAAETNA
080039492OtherRR MEDICARE
B005OtherLATRICARE
2712976009OtherLACIGNA
1376884MedicaidLA

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
I20100129000306 LA Practitioner - Family Practice 9638212624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Mississippi School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Practice Associates ofGroup PAC ID 8628037603, 13 clinicians

Practice addresses (Care Compare)

8383 Millicent Way
Shreveport, LA 71115-5207
Phone (318) 797-6661

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Family Practice Associates of Family Medicine CurrentSince Jul 17, 1989 Accepting new patients

Locations

8383 Millicent Way
Shreveport, LA 71115
Phone (318) 795-8502

Interoperability endpoints

  • Direct secure messaging: timothymathis@tfd.allscriptsdirect.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1119398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1730185927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8383 MILLICENT WAY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711155207",
            "telephone_number": "318-797-6661",
            "fax_number": "318-795-8512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8383 MILLICENT WAY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711155207",
            "telephone_number": "318-797-6661",
            "fax_number": "318-795-8512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "TIMOTHY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-22",
        "last_updated": "2026-09-29",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "07536R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5843480",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "080039492",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "B005",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2712976009",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376884",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.