J Kevin Ingram Medical, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD200671 Issued in LA

Legal business name

J KEVIN INGRAM MEDICAL, INC

Practice address

1806 Carter St
Vidalia, LA 71373-3115

Phone

(318) 757-6526

NPI assigned

Feb 14, 2008

Last updated

Jun 12, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Johnny Kevin Ingram, MDNPI 1437100419

Title

Owner

Phone

(318) 336-8166

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 3

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.

• Johnny Kevin Ingram, M.D.

  • Family Medicine Physician
  • Vidalia, LA
  • NPI 1437100419
  Medicare reassignment NPD Authorized official
• Rebecca Arthur Foster, P.A.

  • Medical Physician Assistant
  • Vidalia, LA
  • NPI 1063759744
  Medicare reassignment
• Kimberly R Fannin - Trisler, APRN

  • Family Nurse Practitioner
  • Winnsboro, LA
  • NPI 1043318991
  NPD (past)

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213228800000",
    "number": "1871761619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14149",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708984149",
            "telephone_number": "888-924-9827",
            "fax_number": "225-924-9829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1806 CARTER ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713733115",
            "telephone_number": "318-757-6526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J KEVIN INGRAM MEDICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2008-06-12",
        "status": "A",
        "authorized_official_last_name": "INGRAM",
        "authorized_official_first_name": "JOHNNY",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-336-8166",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD200671",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1066435",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Johnny Kevin Ingram, M.D.
• Intensive Home Healthcare, Inc
• Intensive Home Healthcare, Inc. (Intensive Home Healthcare and Hospice of Louisiana)
• Lashaun Ivory
• J H Fairbanks MD PLLC
• Amber Jackson
• Ashley Jackson
• Kristie Jackson
• Valerie Jackson
• Tierra Jarvis

• Family Medicine Physician in Vidalia, LA
• Providers in Vidalia, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; 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.