Individual provider Active NPI

John F. Fraiche, M.D.

  • Family Medicine Physician
  • Gonzales, LA
National Provider Identifier
1043218886
Registry record updated Dec 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
013784 Issued in LA
Practice address
2647 S Saint Elizabeth Blvd Ste 100
Gonzales, LA 70737-5019
Phone
(225) 765-5500
Fax
(225) 644-5415
NPI assigned
Jul 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 013784 LA Primary

Addresses

Primary practice location

2647 S Saint Elizabeth Blvd Ste 100
Gonzales, LA 70737-5019

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (225) 765-5727

Other identifiers 1

IdentifierTypeStateIssuer
1193810MedicaidLA

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL jfraiche3399@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100920000814 LA Practitioner - Family Practice 5395733554 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in New Orleans, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2647 S Saint Elizabeth Blvd
Suite 100
Gonzales, LA 70737-5019
Phone (225) 647-8511

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
013784LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Olol-Ascension Family Medicine Current Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Mar 1, 2019 Accepting new patients
Our Lady of the Lake Physician Group LLC Family Medicine CurrentSince Mar 1, 2019 Accepting new patients
Our Lady of the Lake Physician Group LLC Past Accepting new patients
Our Lady of the Lake Ascension, LLC Past Accepting new patients

Locations

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

1961 Staring Ln
Baton Rouge, LA 70810
Phone (225) 374-0055

1702 N Burnside Ave
#B
Gonzales, LA 70737
Phone (225) 647-8319

2647 S Saint Elizabeth Blvd
Ste 100
Gonzales, LA 70737
Phone (225) 743-2707

2647 S Saint Elizabeth Blvd
Ste 125
Gonzales, LA 70737
Phone (225) 647-9675

Networks

  • LA PPO C-SNP

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609286400000",
    "number": "1043218886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "225-765-5727",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2647 S SAINT ELIZABETH BLVD STE 100",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375019",
            "telephone_number": "225-765-5500",
            "fax_number": "225-644-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRAICHE",
        "first_name": "JOHN",
        "middle_name": "F.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2020-12-30",
        "certification_date": "2020-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "013784",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1193810",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "jfraiche3399@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jfraiche3399@direct.casso.us.com",
            "address_1": "2647 S Saint Elizabeth Blvd Ste 100",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2647 S Saint Elizabeth Blvd Ste 100",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gonzales, LA

Sources for this page

Verify at the official NPI Registry.