NPIMap

Organization Active NPI

Affinity Health Group, LLC

Doing business as Affinity Walk-In Clinic

  • Family Medicine Physician
  • Monroe, LA
National Provider Identifier
1750667481
Registry record updated May 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
AFFINITY HEALTH GROUP, LLC
Doing business as
Affinity Walk-In Clinic
Practice address
2408 Broadmoor Blvd Ste B
Monroe, LA 71201-2994
Phone
(318) 807-0525
Fax
(318) 807-1077
NPI assigned
Oct 26, 2011
Last updated
May 28, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2020

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

Authorized official

Name
Mr. Janet Justice
Title
Director of Operations
Phone
(318) 807-7875

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 183500000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

2408 Broadmoor Blvd Ste B
Monroe, LA 71201-2994

Mailing address

130 Desiard St
Suite 355
Monroe, LA 71201-7319
Phone (318) 807-7875

Other names 1

  • Affinity Walk-In Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080411000088 LA Part B Supplier - Clinic/Group Practice 9335226547 Receives reassigned benefits from 165 practitioners
38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monroe, LA; West Monroe, LA; Baton Rouge, LA

Other NPIs on the same Medicare enrollment 31

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 31

National Provider Directory

National Provider Directory
Tax ID family
Affinity Health Group27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Locations

2408 Broadmoor Blvd
Ste B
Monroe, LA 71201
Phone (318) 807-0525

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590624000000",
    "number": "1750667481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST",
            "address_2": "SUITE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017319",
            "telephone_number": "318-807-7875",
            "fax_number": "318-812-9997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2408 BROADMOOR BLVD STE B",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712012994",
            "telephone_number": "318-807-0525",
            "fax_number": "318-807-1077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINITY HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-26",
        "last_updated": "2020-05-28",
        "certification_date": "2020-05-28",
        "status": "A",
        "authorized_official_last_name": "JUSTICE",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "318-807-7875",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Affinity Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Affinity Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2020; 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.