NPIMap

Individual provider Active NPI

Keith J Landry, M.D.

  • Family Medicine Physician
  • Paincourtville, LA
National Provider Identifier
1851404453
Registry record updated Jul 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
017704 Issued in LA
Practice address
114 Highway 403
Paincourtville, LA 70390
Phone
(985) 369-3514
Fax
(985) 252-1400
NPI assigned
Aug 16, 2006
Last updated
Jul 5, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 5, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 017704 LA Primary

Addresses

Primary practice location

114 Highway 403
Paincourtville, LA 70390

Mailing address

PO Box 5478
Thibodaux, LA 70302-5478
Phone (985) 447-5500

Other identifiers 2

IdentifierTypeStateIssuer
300093737OtherLARAILROAD MEDICARE
1348643MedicaidLA

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
I20071024000351 LA Practitioner - Family Practice 7416044318 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3928 Hwy 70 S
Thibodaux Regional Family Medicine
Pierre Part, LA 70339-4460
Phone (985) 252-1111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.55 of 100Reported as group
Quality
67.62
Promoting interoperability
100
Improvement activities
40
Cost
71.34

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17704LAMDClinical Social Worker
017704LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thibodaux Regional Network Development Corporation Current Accepting new patients
Thibodaux Regional Network Development Corporation CurrentSince Jan 1, 2007 Accepting new patients
Thibodaux Regional Network Development Corporation CurrentSince Jan 1, 2007 Accepting new patients
Thibodaux Regional Network Development Corporation Past Accepting new patients

Locations

3928 Highway 70 S
Pierre Part, LA 70339
Phone (985) 252-1111

602 N Acadia Rd
Thibodaux, LA 70301
Phone (985) 493-4544

Organizations & group practices 4

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530748800000",
    "number": "1851404453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5478",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703025478",
            "telephone_number": "985-447-5500",
            "fax_number": "985-449-2535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 HIGHWAY 403",
            "city": "PAINCOURTVILLE",
            "state": "LA",
            "postal_code": "70390",
            "telephone_number": "985-369-3514",
            "fax_number": "985-252-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANDRY",
        "first_name": "KEITH",
        "middle_name": "J",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2018-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "017704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300093737",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1348643",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paincourtville, LA

Sources for this page

Verify at the official NPI Registry.