CENTERWELL SENIOR PRIMARY CARE- SOUTH SHREVEPORT
NPI 1497525661
Internal Medicine in Shreveport, LA

Active since January 08, 2024CLIA 19D2308160 · Waiver
2020 BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71118(407) 447-7120 Get Directions Write a Review

NPPES record last updated: August 22, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Centerwell Senior Primary Care- South Shreveport NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CENTERWELL SENIOR PRIMARY CARE- SOUTH SHREVEPORT (NPI 1497525661) is a healthcare organization registered as an internal medicine in Shreveport, Louisiana and active in the NPI registry since January 2024. The organization holds a CLIA Waiver certificate valid through July 22, 2028 and lists Angie Martinez, Senior Credentialing Professional, as its authorized official.

NPPES Registry Identity

NPI1497525661
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameCENTERWELL SENIOR PRIMARY CARE (LA) PC
Location Address2020 BERT KOUNS INDUSTRIAL LOOPShreveport, LA 71118-3315
Mailing Address6101 Blue Lagoon Dr Ste 200Miami, FL 33126-3168 · (305) 500-2000
Organization SubpartYes
Authorized OfficialAngie MartinezSenior Credentialing Professional · (407) 447-7120
Enumeration DateJanuary 8, 2024
Last NPPES UpdateAugust 22, 2024
NPPES CertifiedAugust 22, 2024
NPI 1497525661 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedGeneral PracticeTaxonomy 208D00000X
2020 BERT KOUNS INDUSTRIAL LOOP, Shreveport, LA 71118

Other Names 1

Doing Business AsCenterwell Senior Primary Care- South Shreveport

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 19D2308160

Centerwell Senior Primary Care - S Shreveport · Shreveport, LA
Active · expires Jul 22, 2028
CLIA Number19D2308160
Laboratory TypePhysician Office
Certificate Effective DateJuly 23, 2026
Certificate Expiration DateJuly 22, 2028
Laboratory DirectorEarl Magee
Laboratory Phone(318) 935-9762
Laboratory LocationCenterwell Senior Primary Care - S Shreveport2020 Bert Kouns Industrial Loop, Shreveport, LA 71118
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
2020 BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT, LA 71118
Nurse Practitioner (Family)
2020 BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT, LA 71118

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Centerwell Senior Primary Care (la) PC's NPI number?

The NPI number for Centerwell Senior Primary Care (la) PC is 1497525661. It was assigned to this organization in the NPPES registry on January 8, 2024. The provider is doing business as Centerwell Senior Primary Care- South Shreveport.

Where is Centerwell Senior Primary Care (la) PC located?

Centerwell Senior Primary Care (la) PC is located at 2020 Bert Kouns Industrial Loop, Shreveport, LA 71118. The listed phone number is (407) 447-7120.

What is Centerwell Senior Primary Care (la) PC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Centerwell Senior Primary Care (la) PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 19D2308160) is associated with this NPI, valid through July 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Centerwell Senior Primary Care (la) PC was last updated on August 22, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.