NPI |
1205292539 |
The first name of the provider, if the provider
is an individual. |
Entity Type Code |
1 |
The middle name of the provider, if the provider
is an individual. |
Provider Last Name Legal Name |
CHRISTY |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider First Name |
RONALD |
The first name of the provider, if the provider
is an individual. |
Provider Name Prefix Text |
MR. |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider First Line Business Practice Location Address |
6305 ELYSIAN FIELDS AVE |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Second Line Business Practice Location Address |
SUITE 405 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address City Name |
NEW ORLEANS |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
LA |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
701224245 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Telephone Number |
5043247332 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Fax Number |
5043247339 |
The code designating the provider’s gender if the provider is a person. |
Provider Enumeration Date |
12/31/2015 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Last Update Date |
12/31/2015 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Gender Code |
M |
|
Healthcare Provider Taxonomy Code 1 |
101YM0800X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Healthcare Provider Taxonomy Code 2 |
104100000X |
|
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |