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Kodi Fay Crisp-Coleman

Family Medicine

Allopathic & Osteopathic Physicians

9001 Summa Avenue, Baton Rouge, LA 70809-3726

PECOS Enrollment

This provider is enrolled in PECOS as KODI CRISP- COLEMAN.

Based on the most recent information from CMS, provider Kodi Fay Crisp-Coleman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1437327905
Provider Type
Individual
Full Name
Crisp-Coleman, Kodi Fay
Title
Dr.
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
2/18/2008
Last Updated
12/6/2010

Contact Information

Practice Location

9001 Summa Avenue, Baton Rouge, LA 70809-3726

(225) 761-5480

Unlisted Fax

Mailing Location

1514 Jefferson Highway, New Orleans, LA 70121

(504) 842-4000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License MD.204059 Louisiana
Code 207Q00000X	Description Family Medicine Allopathic & Osteopathic Physicians	License GETP.EBR.FP Louisiana

Provider Identifiers

ID	Description	Issuer
ID 08077518	Description Medicaid	Issuer Unlisted Mississippi
ID GETP.EBR.FP	Description Other	Issuer TEMPORARY LICENSE NUMBER Louisiana
ID 1000281	Description Medicaid	Issuer Unlisted Louisiana

Kodi Fay Crisp-Coleman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

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Issuer

ID

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Kermis, Rachael

Gaspard, Brad J.

Duplechain, Michael

Baton Rouge General Physicians, Inc.

Med-Aid Clinic

Reddy, Shilpa Mainampati

Ishler, Harold Leroy

James, Trenton L.

Papcsy, Leigh Danielle

Jeffries, Edward E