NPIMap

Organization Active NPI

Affinity Health Group, LLC

Doing business as Pedicatrics Plus, AMC

  • Pediatric Adolescent Medicine Physician
  • Monroe, LA
National Provider Identifier
1811948037
Registry record updated Jul 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
AFFINITY HEALTH GROUP, LLC
Doing business as
Pedicatrics Plus, AMC
Practice address
3401 Magnolia CV
Monroe, LA 71203-2375
Phone
(318) 325-6311
Fax
(318) 361-9805
NPI assigned
May 12, 2006
Last updated
Jul 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2011

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

Authorized official

Name
Mr. Mike Breard
Title
Vice President
Phone
(318) 361-0900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X NU
Pediatric Adolescent Medicine Physician 2080A0000X NU Primary

Addresses

Primary practice location

3401 Magnolia CV
Monroe, LA 71203-2375

Mailing address

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

Other names 1

  • PEDICATRICS PLUS, AMC 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

Locations

3401 Magnolia Cv
Monroe, LA 71203
Phone (318) 325-6311

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1811948037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST",
            "address_2": "STE 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": "3401 MAGNOLIA CV",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712032375",
            "telephone_number": "318-325-6311",
            "fax_number": "318-361-9805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINITY HEALTH GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "BREARD",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "318-361-0900",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEDICATRICS PLUS, AMC",
            "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 Jul 5, 2011; 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.