Individual provider Active NPI

Ileana Maria Serrano Herrera, MD

  • Pediatric Nephrology Physician
  • New York, NY
National Provider Identifier
1912492711
Registry record updated Apr 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
339409 Issued in LA
Practice address
3959 Broadway FL Chn11
New York, NY 10032-1559
Phone
(212) 305-5825
NPI assigned
Jun 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 312215-0 NY
Pediatric Nephrology Physician 2080P0210X 339409 LA Primary

Addresses

Primary practice location

3959 Broadway FL Chn11
New York, NY 10032-1559

Mailing address

3959 Broadway FL Chn11
New York, NY 10032-1559
Phone (212) 305-5825

Other practice location 1

8200 Constantin Blvd Fl 4
Baton Rouge, LA 70809-3481
Phone (225) 765-5500

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address iserranoherrera5328318@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240507001611 LA Practitioner - Pediatric Medicine 3173964269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Henry Clay Ave
New Orleans, LA 70118-5720
Phone (504) 412-1860

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
312215-0NYMDPediatrics Physician
339409LAMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group, LLC CurrentSince Feb 19, 2025 Accepting new patients
Louisiana State University School of Med in New Orleans Faculty Grou Pediatrics CurrentSince Jul 1, 2024 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Feb 19, 2025 Accepting new patients
Our Lady of the Lake Physician Group LLC Pediatrics Current Accepting new patients
Children'S Hospital Past Accepting new patients
Lsuhsc New Orleans Physicians Pediatrics Past Accepting new patients

Locations

8200 Constantin Blvd
Fl 4
Baton Rouge, LA 70809

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

200 Henry Clay Ave
New Orleans, LA 70118
Phone (504) 412-1860

Interoperability endpoints

  • Direct secure messaging: ileana.serrano.1@18107.direct.athenahealth.com
  • Direct secure messaging: iserranoherrera5328318@direct.casso.us.com

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744243200000",
    "number": "1912492711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3959 BROADWAY FL CHN11",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321559",
            "telephone_number": "212-305-5825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3959 BROADWAY FL CHN11",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100321559",
            "telephone_number": "212-305-5825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8200 Constantin Blvd Fl 4",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708093481",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-765-1202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SERRANO HERRERA",
        "first_name": "ILEANA",
        "middle_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-25",
        "last_updated": "2025-04-10",
        "certification_date": "2025-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "312215-0",
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "LA",
            "license": "339409",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "iserranoherrera5328318@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "iserranoherrera5328318@direct.casso.us.com",
            "address_1": "8200 Constantin Blvd Fl 4",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708093481",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "8200 Constantin Blvd Fl 4",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708093481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.