Individual provider Active NPI

Sara Amend Blankenship

  • Nurse Practitioner
  • Shreveport, LA
National Provider Identifier
1811518780
Registry record updated Jun 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
213810 Issued in LA
Practice address
1811 E Bert Koun Loop Ste 400
Shreveport, LA 71105-5764
Phone
(318) 212-3810
Fax
(318) 212-3815
NPI assigned
May 2, 2020
Last updated
Jun 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN134042 LA
Nurse Practitioner 363L00000X 213810 LA Primary

Addresses

Primary practice location

1811 E Bert Koun Loop Ste 400
Shreveport, LA 71105-5764

Mailing address

1811 E Bert Koun Loop Ste 400
Shreveport, LA 71105-5764
Phone (318) 212-3810

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210429001413 LA Practitioner - Nurse Practitioner 5294144432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Pierremont Family PhysiciansGroup PAC ID 0143320465, 6 clinicians

Practice addresses (Care Compare)

1811 E Bert Kouns Industrial Loop
Suite 400
Shreveport, LA 71105-5764
Phone (318) 212-3810

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN134042LAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
WK Pierremont Family Physicians CurrentSince Jan 26, 2021 Accepting new patients

Locations

1202 Louisiana Ave
Shreveport, LA 71101
Phone (318) 212-8946

1811 E Bert Kouns Industrial Loop
Ste 400
Shreveport, LA 71105
Phone (318) 212-3810

Interoperability endpoints

  • Direct secure messaging: sblankens2@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 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": "1588377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623974400000",
    "number": "1811518780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 E BERT KOUN LOOP STE 400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055764",
            "telephone_number": "318-212-3810",
            "fax_number": "318-212-3815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 E BERT KOUN LOOP STE 400",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055764",
            "telephone_number": "318-212-3810",
            "fax_number": "318-212-3815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANKENSHIP",
        "first_name": "SARA",
        "middle_name": "AMEND",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-02",
        "last_updated": "2021-06-18",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "LA",
            "license": "RN134042",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "213810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.