NPIMap

Organization Active NPI

Centerwell Senior Primary Care (la) PC

  • Internal Medicine Physician
  • Bossier City, LA
National Provider Identifier
1760005136
Registry record updated Nov 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CENTERWELL SENIOR PRIMARY CARE (LA) PC
Practice address
2900 E Texas St Ste 100
Bossier City, LA 71111-3275
Phone
(318) 606-6737
Fax
(833) 749-0343
NPI assigned
May 20, 2020
Organization subpart
Yes
Parent organization
CENTERWELL SENIOR PRIMARY CARE (LA) PCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Angie Martinez
Title
Senior Credentialing Professional
Phone
(407) 447-7120

Other NPIs on the same Medicare enrollment 13

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

View all 13

Corporate family (same tax ID) 13

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

View all 13

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 60

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2186079Centerwell Senior Primary Care-Bossier City2900 E Texas St, Suite 100, Bossier City, LA 71111Certificate of waiverJun 14, 2028

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210217000212 LA Part B Supplier - Clinic/Group Practice 1951712280 Receives reassigned benefits from 60 practitioners
13 other NPIs on this enrollment
Practice locations: Denham Springs, LA; Slidell, LA; Shreveport, LA; Prairieville, LA; Opelousas, LA; New Orleans, LA; Marrero, LA; Lake Charles, LA…

National Provider Directory

National Provider Directory
Tax ID family
Centerwell Senior Prim Care (14 organizations share this tax ID)
Part of
Centerwell Senior Prim Care

Locations

2900 E Texas St
Ste 100200
Bossier City, LA 71111

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

NPPES NPI Registry

Primary practice location

2900 E Texas St Ste 100
Bossier City, LA 71111-3275

Mailing address

4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (407) 447-7120

Other names 3

NPPES NPI Registry
  • CenterWell Senior Primary Care-Bossier City Doing business as
  • Partners in Primary Care- Bossier City Doing business as
  • Partners in Primary Care LA PC Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 7, 2022.

{
    "created_epoch": "1589932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667779200000",
    "number": "1760005136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 MILLENIA BLVD STE 650",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328396013",
            "telephone_number": "407-447-7120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 E TEXAS ST STE 100",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711113275",
            "telephone_number": "318-606-6737",
            "fax_number": "833-749-0343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERWELL SENIOR PRIMARY CARE (LA) PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTERWELL SENIOR PRIMARY CARE (LA) PC",
        "enumeration_date": "2020-05-20",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING PROFESSIONAL",
        "authorized_official_telephone_number": "407-447-7120"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CenterWell Senior Primary Care-Bossier City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care- Bossier City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care- Bossier City",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Partners in Primary Care LA PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bossier City, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.