NPIMap

Individual provider Active NPI

Bradley Lane Jimerson, DPM

  • Foot & Ankle Surgery Podiatrist
  • Lake Charles, LA
National Provider Identifier
1013579150
Registry record updated Jul 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
322786 Issued in LA
Practice address
1747 Imperial Blvd
Lake Charles, LA 70605-5362
Phone
(337) 721-7236
Fax
(337) 721-7237
NPI assigned
Jun 28, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2022

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 PO9593 LA
Foot & Ankle Surgery Podiatrist 213ES0103X 322786 LA Primary

Addresses

Primary practice location

1747 Imperial Blvd
Lake Charles, LA 70605-5362

Mailing address

1747 Imperial Blvd
Lake Charles, LA 70605-5362
Phone (337) 721-7236

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
I20220714003674 LA Practitioner - Podiatry 6002297520 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
College of Podiatric Med and Surgery, Des Moines University, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Orthopaedics and Spine LLC 32 clinicians

Practice addresses (Care Compare)

1747 Imperial Blvd
Lake Charles, LA 70605-5362
Phone (337) 721-7236

Hospital & facility affiliations

  • Vitalcaring Group Home health agency, Basile, LA, CCN 197038
  • Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060
  • Christus Ochsner St Patrick Hospital Hospital, Lake Charles, LA, CCN 190027
  • Christus Ochsner Lake Area Hospital Hospital, Lake Charles, LA, CCN 190201
  • West Calcasieu Cameron Hospital Hospital, Sulphur, LA, CCN 190013

Merit-based Incentive Payment System (MIPS)

Final score
57.44 of 100Reported as individual
Quality
26.44
Promoting interoperability
93
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10
Melanoma (skin cancer) excision1-10
Removal of tissue163
Removal of nail tissue45
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PO9593LAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Orthopaedics and Spine LLC Foot & Ankle Surgery CurrentSince Jul 18, 2022 Accepting new patients
Center for Orthopaedics and Spine LLC Foot & Ankle Surgery CurrentSince Jul 18, 2022 Accepting new patients

Locations

1355 Sam Houston Jones Pkwy
Ste 340
Lake Charles, LA 70611
Phone (337) 721-7236

1747 Imperial Blvd
Lake Charles, LA 70605
Phone (337) 721-7236

Interoperability endpoints

  • Direct secure messaging: bjimerson5287515@direct.casso.us.com

Organizations & group practices 2

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

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656633600000",
    "number": "1013579150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1747 IMPERIAL BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055362",
            "telephone_number": "337-721-7236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1747 IMPERIAL BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055362",
            "telephone_number": "337-721-7236",
            "fax_number": "337-721-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMERSON",
        "first_name": "BRADLEY",
        "middle_name": "LANE",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-28",
        "last_updated": "2022-07-01",
        "certification_date": "2022-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "LA",
            "license": "PO9593",
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "LA",
            "license": "322786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.