Anthony Jude Palazzo, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

MD.07154R Issued in LA

Practice address

405 Avenue F
Bogalusa, LA 70427-3633

Phone

(985) 732-1568

Fax

(985) 732-4458

NPI assigned

Jun 18, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Electronic endpoints 2

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

Specialty

Pediatric Medicine

Education

Other, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clinics of the Southeast LLCGroup PAC ID 6709116239, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: apalazzo15843@direct.casso.us.com

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Clinics of the Southeast LLC

  dba Bogalusa Family Medicine & Behavioral Health

  • Rural Health Clinic/Center
  • Bogalusa, LA
  • NPI 1053082743

  5% Or Greater Direct Ownership Interest, Corporate Officer, General Partnership Interest, Operational/Managerial Control

  CMS ownership
• Clinics of the Southeast LLC

  dba Bogalusa Pediatric Clinic

  • Rural Health Clinic/Center
  • Bogalusa, LA
  • NPI 1053979815

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

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.

• Clinics of the Southeast LLC

  dba Bogalusa Pediatric Clinic

  • Rural Health Clinic/Center
  • Bogalusa, LA
  • NPI 1053979815

  Pediatrics

  Medicare reassignment Care Compare group NPD Authorized official
• Anthony J. Palazzo, M.D.,Apmc

  dba The Pediatric Clinic

  • Pediatric Nurse Practitioner
  • Bogalusa, LA
  • NPI 1285751362
  Medicare reassignment NPD Authorized official
• Clinics of the Southeast LLC

  dba Bogalusa Family Medicine & Behavioral Health

  • Rural Health Clinic/Center
  • Bogalusa, LA
  • NPI 1053082743
  NPD Authorized official
• Wash-St Tammany Reg Medical Center

  dba Bogalusa Medical Center

  • General Acute Care Hospital
  • Bogalusa, LA
  • NPI 1508809088
  NPD

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1063457554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 370",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704290370",
            "telephone_number": "985-732-1568",
            "fax_number": "985-732-4458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 AVENUE F",
            "city": "BOGALUSA",
            "state": "LA",
            "postal_code": "704273633",
            "telephone_number": "985-732-1568",
            "fax_number": "985-732-4458"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "433 Plaza St",
            "address_purpose": "LOCATION",
            "city": "Bogalusa",
            "state": "LA",
            "postal_code": "704273729",
            "country_code": "US",
            "telephone_number": "985-730-6700",
            "fax_number": "985-732-4458",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PALAZZO",
        "first_name": "ANTHONY",
        "middle_name": "JUDE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "LA",
            "license": "MD.07154R",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "LA",
            "license": "MD.07154R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1367061",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00018495",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4402936",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "19669647423",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "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": "433 Plaza St",
            "city": "Bogalusa",
            "state": "LA",
            "country_code": "US",
            "postal_code": "704273729",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "apalazzo15843@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "apalazzo15843@direct.casso.us.com",
            "address_1": "433 Plaza St",
            "city": "Bogalusa",
            "state": "LA",
            "country_code": "US",
            "postal_code": "704273729",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pediatric Adolescent Medicine Physician in Bogalusa, LA
• Providers in Bogalusa, LA by specialty
• Pediatric Adolescent Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.