NPIMap

Individual provider Active NPI

Randall G White, MD

  • Nephrology Physician
  • Shreveport, LA
National Provider Identifier
1801851522
Registry record updated Dec 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
020186 Issued in LA
Practice address
745 Olive St
Suite 200
Shreveport, LA 71104-2246
Phone
(318) 226-0809
Fax
(318) 226-0812
NPI assigned
Apr 18, 2006
Last updated
Dec 9, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 020186 LA Primary

Addresses

Primary practice location

745 Olive St
Suite 200
Shreveport, LA 71104-2246

Mailing address

745 Olive St
Suite 200
Shreveport, LA 71104-2246
Phone (318) 226-0809

Other identifiers 2

IdentifierTypeStateIssuer
1966118MedicaidLA
L020186OtherLAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100308000123 LA Practitioner - Nephrology 8123163706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Louisiana State University School of Medicine in Shreveport, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delta Nephrology LLCGroup PAC ID 2062714017, 2 clinicians

Practice addresses (Care Compare)

745 Olive St
Suite 200
Shreveport, LA 71104-2246
Phone (318) 213-2213

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
020186LAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Delta Nephrology LLC Nephrology CurrentSince Jan 1, 2016 Accepting new patients

Locations

745 Olive St
Ste 200
Shreveport, LA 71104
Phone (318) 213-2213

Interoperability endpoints

  • Direct secure messaging: rwhite@direct.wkhs.com

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 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260316800000",
    "number": "1801851522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 OLIVE ST",
            "address_2": "SUITE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042246",
            "telephone_number": "318-226-0809",
            "fax_number": "318-226-0812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 OLIVE ST",
            "address_2": "SUITE 200",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042246",
            "telephone_number": "318-226-0809",
            "fax_number": "318-226-0812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "RANDALL",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-18",
        "last_updated": "2009-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "020186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1966118",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "L020186",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.