NPIMap

Organization Active NPI

Jefferson Davis Physician Services, LLC

  • Hospitalist Physician
  • Jennings, LA
National Provider Identifier
1942679352
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
JEFFERSON DAVIS PHYSICIAN SERVICES, LLC
Practice address
1634 Elton Rd
Jennings, LA 70546-3614
Phone
(800) 893-9698
NPI assigned
Sep 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Lisha C Falk
Title
VP of Contracting
Phone
(337) 609-1221

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208M00000X LA Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X LA
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X LA

Addresses

Primary practice location

1634 Elton Rd
Jennings, LA 70546-3614

Mailing address

200 Coporate Blvd.
Lafayette, LA 70508

Other identifiers 1

IdentifierTypeStateIssuer
2406141MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160113001922 LA Part B Supplier - Clinic/Group Practice 7517269152 Receives reassigned benefits from 44 practitioners
Practice locations: Jennings, LA

National Provider Directory

National Provider Directory

Locations

708 E Russell Ave
Welsh, LA 70591
Phone (337) 734-4500

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1942679352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 COPORATE BLVD.",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1634 ELTON RD",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705463614",
            "telephone_number": "800-893-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON DAVIS PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-16",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "LISHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF CONTRACTING",
        "authorized_official_telephone_number": "337-609-1221"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": "LA",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2406141",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jennings, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.