John Alanson Fudickar

NPI1841218484

Summary

Provider Details

NPI Number 1841218484
Provider Name John Alanson Fudickar
Credential PA
Specialization
Medical School Name Other
Graduation Year 1998
Gender M
Entity Type Individual
PAC ID by PECOS 7416912688
Professional Enrollment ID I20041130000262
Enumeration Date 07/18/2006
Last Update Date 03/13/2012

Contact Details

Business Practice address 12525 PERKINS RD, Baton Rouge,
70810-1907 Louisiana View on Google Map
Business Practice phone 225-819-8857
Business Practice fax 225-767-6822
Mailing address 7777 HENNESSY BLVD, Baton Rouge,
70808-4300 Louisiana View on Google Map
Other phone 225-214-9352
Other fax 225-214-9349
Email Address shannonfig@domain.com Reval Email Address
Incorrect information? Update the NPI Details for John Alanson Fudickar PA Update NPI

Payments

Total Payment Worth

$40.82
from 5 payments in the last 6 years

Total Cash or Cash Equivalent

$0.00
from 0 payments in the last 6 years

Total In-kind Items & Services

$40.82
from 5 payments in the last 6 years

Hospital Affilitation

Practices in Baton Rouge

Baton Rouge, Louisiana

Education & Training

Other

1998

Group Affiliation

Organization Name PECOS PAC ID Members
Total Urgent Care 7517398282 5
Convenient Care Llc 1153306816 61
Newsletter for Healthcare Professionals

Provider Taxonomy Details

Primary Taxonomy
Speciality
Taxonomy
License No.
PA.A10367.RX (Louisiana)

Reference NPI Information (as per NPPES NPI Record)

Field Name Field Value
NPI 1841218484
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Entity Type Individual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor N
Indicate whether provider is a sole proprietor.
  • A sole proprietor is the sole (the only) owner of a business that is not incorporated; that unincorporated business is a sole proprietorship.
  • In a sole proprietorship, the sole proprietor owns all of the assets of the business and is solely liable for all of the debts of the business.
  • There is no difference between a sole proprietorship and a sole proprietor; they are legally a single entity: an individual.
  • In terms of NPI assignment, a sole proprietor is an Entity type 1 (Individual) and is eligible for only one NPI (the sole proprietorship business is not eligible for its own NPI).
  • As an individual, a sole proprietorship cannot be a subpart and cannot have subparts. (See NPI Final Rule for information about subparts.)
  • A sole proprietorship may or may not have employees.
  • Often, the IRS assigns an EIN to a sole proprietorship in order to protect the sole proprietor's SSN from disclosure in claims or on W-2s. NPPES does not capture a sole proprietorship's EIN.
  • Many types of health care providers could be sole proprietorships (for example, group practices, pharmacies, home health agencies).
Provider Last Name (Legal Name) Fudickar
The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Name John
The first name of the provider, if the provider is an individual.
Provider Credential Text PA
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address 7777 HENNESSY BLVD
The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
Provider Business Mailing Address City Name Baton Rouge
The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
Provider Business Mailing Address State Name Louisiana
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
Provider Business Mailing Address Postal Code 70808-4300
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
Provider Business Mailing Address Country Code US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Telephone Number 225-214-9352
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
Provider Business Mailing Address Fax Number 225-214-9349
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
Provider First Line Business Practice Location Address 12525 PERKINS RD
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 Business Practice Location Address City Name Baton Rouge
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name Louisiana
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code 70810-1907
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number 225-819-8857
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number 225-767-6822
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date 07/18/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date 03/13/2012
The date that a record was last updated or changed.
Provider Gender Code M
The code designating the provider's gender if the provider is a person.
Provider Gender Male
The provider's gender if the provider is a person.
Healthcare Provider Taxonomy Code #1 363A00000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1 A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Healthcare Provider Taxonomy #1
Provider License Number 1 PA.A10367.RX
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1 LA
Provider License Number State Code #1
Healthcare Provider Primary Taxonomy Switch 1 Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.