Individual provider Active NPI

Brooks Lee Vial, PA-C

  • Physician Assistant
  • Metairie, LA
National Provider Identifier
1063031490
Registry record updated Jun 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3939 Houma Blvd Ste 21
Metairie, LA 70006-2921
Phone
(985) 212-4286
NPI assigned
Apr 15, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

3939 Houma Blvd Ste 21
Metairie, LA 70006-2921

Mailing address

3939 Houma Blvd Ste 21
Metairie, LA 70006-2921

Other practice location 1

14041 Highway 90
Boutte, LA 70039
Phone (985) 764-3001

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200925001842 LA Practitioner - Physician Assistant 4880013788 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pontchartrain Bone and Joint Clinic LTDGroup PAC ID 8426091497, 18 clinicians

Practice addresses (Care Compare)

3939 Houma Blvd
Suite 21
Metairie, LA 70006-2921
Phone (504) 885-6464

Hospital & facility affiliations

  • East Jefferson General Hospital Hospital, Metairie, LA, CCN 190176

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pontchartrain Bone & Joint Clinic, LTD. Single Specialty CurrentSince Dec 1, 2023 Accepting new patients
LMG, LLC Single Specialty CurrentSince Aug 3, 2020 Accepting new patients

Locations

14041 Highway 90
Boutte, LA 70039
Phone (504) 503-6445

1151 Barataria Blvd
Ste 4300
Marrero, LA 70072
Phone (504) 934-8140

4633 Wichers Dr
Marrero, LA 70072
Phone (504) 347-5421

3939 Houma Blvd
Ste 21
Metairie, LA 70006
Phone (504) 885-6464

Organizations & group practices 3

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 4

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": "1586908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1063031490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3939 HOUMA BLVD STE 21",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700062921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3939 HOUMA BLVD STE 21",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700062921",
            "telephone_number": "985-212-4286"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14041 Highway 90",
            "address_purpose": "LOCATION",
            "city": "Boutte",
            "state": "LA",
            "postal_code": "70039",
            "country_code": "US",
            "telephone_number": "985-764-3001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIAL",
        "first_name": "BROOKS",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Metairie, LA

Sources for this page

Verify at the official NPI Registry.