NPIMap

Individual provider Active NPI

Jessica Leblanc, MD

  • Dermatology Physician
  • Zachary, LA
National Provider Identifier
1013235647
Registry record updated Jan 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD.206923 Issued in LA
Practice address
4727 W Park Dr Ste B
Zachary, LA 70791-4090
Phone
(225) 769-4044
Fax
(225) 246-9100
NPI assigned
May 6, 2010
Last updated
Jan 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Dermatology Physician 207N00000X MD.206923 LA Primary

Addresses

Primary practice location

4727 W Park Dr Ste B
Zachary, LA 70791-4090

Mailing address

7373 Perkins Rd
Baton Rouge, LA 70808-4373
Phone (225) 246-9790

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150730012913 LA Practitioner - Dermatology 0749422996 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Louisiana State University School of Medicine in Shreveport, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

19900 Old Scenic Hwy
Suite Fastlane
Zachary, LA 70791-7368
Phone (225) 570-2618

2335 Church St
Suite E
Zachary, LA 70791-2700
Phone 22565436075121

4801 McHugh Rd
Zachary, LA 70791-5364
Phone (225) 658-4000

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision16
Removal of skin lesions465
Removal or shaving of skin growth17
Skin biopsy109

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.206923LAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
W Trent Massengale, MD LLC Dermatology CurrentSince Feb 1, 2017 Accepting new patients
Hospital Service District 1 of East Baton Rouge Parish CurrentSince Dec 1, 2021 Accepting new patients
Hospital Service District 1 of East Baton Rouge Parish CurrentSince Dec 1, 2021 Accepting new patients
Hospital Service District 1 of East Baton Rouge Parish Current Accepting new patients
Hospital Service District 1 of East Baton Rouge Parish Past Accepting new patients
Dpi Pain Management LLC PastSince Jan 19, 2020 Accepting new patients

Locations

17503 Old Jefferson Hwy
Prairieville, LA 70769
Phone (225) 313-4560

19900 Old Scenic Hwy
Ste E
Zachary, LA 70791
Phone (225) 570-2618

2335 Church St
Zachary, LA 70791
Phone (225) 654-3607

2335 Church St
Ste E
Zachary, LA 70791
Phone (225) 570-2489

4801 McHugh Rd
#C
Zachary, LA 70791
Phone (225) 570-2489

6300 Main St
Zachary, LA 70791
Phone (225) 570-2618

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578960000000",
    "number": "1013235647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7373 PERKINS RD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084373",
            "telephone_number": "225-246-9790",
            "fax_number": "225-246-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4727 W PARK DR STE B",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707914090",
            "telephone_number": "225-769-4044",
            "fax_number": "225-246-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBLANC",
        "first_name": "JESSICA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-06",
        "last_updated": "2020-01-14",
        "certification_date": "2020-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "LA",
            "license": "MD.206923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Zachary, LA

Sources for this page

Verify at the official NPI Registry.