Organization Active NPI

Indira Sastry and Willis-Knighton

  • Pulmonary Disease Physician
  • Shreveport, LA
National Provider Identifier
1972569846
Registry record updated Oct 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
INDIRA SASTRY AND WILLIS-KNIGHTON
Practice address
2533 Bert Kouns Loop
Suite 106
Shreveport, LA 71118-3158
Phone
(318) 212-5976
Fax
(318) 212-5986
NPI assigned
Apr 21, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2013

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

Authorized official

Name
Greg J. Gavin
Title
Network Administrator
Phone
(318) 212-5976

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

2533 Bert Kouns Loop
Suite 106
Shreveport, LA 71118-3158

Mailing address

2533 Bert Kouns Loop
Suite 106
Shreveport, LA 71118-3158
Phone (318) 212-5976

Other identifiers 1

IdentifierTypeStateIssuer
1448877MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050525000439 LA Part B Supplier - Clinic/Group Practice 7012959539 Receives reassigned benefits from 1 practitioner
Practice locations: Shreveport, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2514 Bert Kouns Industrial Loop
Ste 5
Shreveport, LA 71118
Phone (318) 212-5976

2508 Bert Kouns Industrial Loop
Ste 300
Shreveport, LA 71118
Phone (318) 212-5757

2508 Bert Kouns Industrial Loop
Ste 304B
Shreveport, LA 71118
Phone (318) 212-5976

1666 E Bert Kouns Industrial Loop
Ste 225
Shreveport, LA 71105
Phone (318) 524-9101

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1145577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380585600000",
    "number": "1972569846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2533 BERT KOUNS LOOP",
            "address_2": "SUITE 106",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183158",
            "telephone_number": "318-212-5976",
            "fax_number": "318-212-5986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2533 BERT KOUNS LOOP",
            "address_2": "SUITE 106",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711183158",
            "telephone_number": "318-212-5976",
            "fax_number": "318-212-5986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIRA SASTRY AND WILLIS-KNIGHTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-21",
        "last_updated": "2013-10-01",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "GREG",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "NETWORK ADMINISTRATOR",
        "authorized_official_telephone_number": "318-212-5976"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1448877",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2013; 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.