Active NPI
Jay Jiekuen Lou, M.D.
- Allergy & Immunology Physician
- Shoreview, MN
National Provider Identifier
1881657872
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 38717
- Practice address
- 4625 Churchill St
Suite 211
Shoreview, MN 55126-5868 - Phone
- (651) 765-9800
- Fax
- (651) 765-9801
- NPI assigned
- Apr 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 38717 | MN | Primary |
Addresses
Primary practice location
4625 Churchill St
Suite 211
Shoreview, MN 55126-5868
Mailing address
4625 Churchill St
Suite 211
Shoreview, MN 55126-5868
Phone (651) 765-9800
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00098375 | Other | MEDICARE RAILROAD | |
| 375175000 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38717 | MN | MD | Allergy & Immunology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| One Stop Medical Center | Past | Accepting new patients | |
| Columbia Park Medical Group, PA | Allergy & Immunology | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Fridley, MN
- NPI 1932150117
Allergy & Immunology
-
- Clinic/Center
- Casselberry, FL
- NPI 1336335066
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196121600000",
"number": "1881657872",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4625 CHURCHILL ST",
"address_2": "SUITE 211",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551265868",
"telephone_number": "651-765-9800",
"fax_number": "651-765-9801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4625 CHURCHILL ST",
"address_2": "SUITE 211",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551265868",
"telephone_number": "651-765-9800",
"fax_number": "651-765-9801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOU",
"first_name": "JAY",
"middle_name": "JIEKUEN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-10",
"last_updated": "2007-11-27",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "MN",
"license": "38717",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00098375",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "375175000",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shoreview, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.