NPIMap

Organization Active NPI

Shreveport Surgery Center Ptrshp

  • Anesthesiology Physician
  • Shreveport, LA
National Provider Identifier
1992925135
Registry record updated Sep 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
SHREVEPORT SURGERY CENTER PTRSHP
Practice address
745 Olive St
Suite 100
Shreveport, LA 71104-2246
Phone
(318) 227-1163
Fax
(318) 227-0413
NPI assigned
Apr 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2013

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

Authorized official

Name
Miss Mary Bridges, RN
Title
Administrator
Phone
(318) 227-1163

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

745 Olive St
Suite 100
Shreveport, LA 71104-2246

Mailing address

PO Box 4825
Shreveport, LA 71134-0825
Phone (318) 227-1163

Other identifiers 2

IdentifierTypeStateIssuer
1900G9962ZOtherLAMEDICAL STAFF # BCBS LA
1447552MedicaidLA

Other names 1

  • Shreveport Surgery Anesthesia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050210000899 LA Part B Supplier - Clinic/Group Practice 9830141597 Receives reassigned benefits from 6 practitioners
Practice locations: Shreveport, LA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shreveport Surg Ctr Ptrshp2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

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": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378944000000",
    "number": "1992925135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4825",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711340825",
            "telephone_number": "318-227-1163",
            "fax_number": "318-227-0413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 OLIVE ST",
            "address_2": "SUITE 100",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042246",
            "telephone_number": "318-227-1163",
            "fax_number": "318-227-0413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT SURGERY CENTER PTRSHP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2013-09-12",
        "status": "A",
        "authorized_official_last_name": "BRIDGES",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "318-227-1163",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL STAFF # BCBS LA",
            "identifier": "1900G9962Z",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447552",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shreveport Surgery Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Sep 12, 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.