Pratibha Anne, MD
Individual provider Active NPI Family Medicine Physician · Shreveport, LA
NPI 1821228909 · NPPES record last updated Oct 14, 2010
Key facts
- NPI
- 1821228909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 203834 (LA)
- Practice address
- 1625 David Raines Rd
Shreveport, LA 71107-5899 - Phone
- (318) 425-2252
- Fax
- (318) 227-3357
- NPI assigned
- Jul 22, 2009
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2002
- Medicare assignment
- May accept Medicare assignment
- Group practices
- WK Frederick and Braud Clinic
Physical Therapy Services of West Louisiana Inc
Practice addresses (Care Compare)
2508 Bert Koun Loop
Suite 102
Shreveport, LA 71118-3175
Phone (318) 212-5777
301 W Fertitta Blvd
Suite 4
Leesville, LA 71446-4665
Phone (337) 238-9931
Hospital & facility affiliations
- Willis Knighton Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110104000878 | LA | Practitioner - Family Practice | 9638368871 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 203834 | LA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David Raines Community Health Center, Inc | Current | Accepting new patients | |
| David Raines Community Health Center, Inc | Current |
Accepting new patients | |
| WK Frederick and Braud Clinic | Family Medicine | Current |
Accepting new patients |
| David Raines Community Health Center Inc | Current |
Accepting new patients |
Locations
1514 Doctors Dr
Bossier City, LA 71111
Phone (318) 549-2500
3021 W 70th St
Shreveport, LA 71108
Phone (318) 227-3350
1625 David Raines Rd
Shreveport, LA 71107
Phone (318) 425-2252
2508 Bert Kouns Industrial Loop
Ste 102
Shreveport, LA 71118
Phone (318) 212-5777
3041 Dr Martin Luther King Dr
Shreveport, LA 71107
Phone (318) 227-3350
Interoperability endpoints
- panne@direct.wkhs.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 203834 | LA | Yes |
Addresses
Primary practice location
1625 David Raines Rd
Shreveport, LA 71107-5899
Mailing address
1625 David Raines Rd
Shreveport, LA 71107-5899
Phone (318) 425-2252
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06568919 | Other | ECFMG | |
| 203834 | Other | LA | STATE LICENSE |
Other providers in Shreveport, LA
- Edward L Anglin
- Anil Veluvolu MD and Willis-Knighton Medical Center
- Bhrugun Anisetti
- Kristina Gambino Annaloro
- Patrick Annaloro
- Anointed Reign Healthcare,LLC
- Junaid Ansari
- Mohammad Ansari
- Misty Marlene Anthony-McAllister
- Asian Anthony
All providers in Shreveport, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.