NPIMap

Organization Active NPI

Lsuhsc Family Practice Center @ LCMH

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1073514493
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LSUHSC FAMILY PRACTICE CENTER @ LCMH
Practice address
1525 Oak Park Blvd
Lake Charles, LA 70601-8849
Phone
(337) 494-6767
Fax
(337) 494-6750
NPI assigned
Aug 9, 2005
Last updated
Dec 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Dawn Johnson-Hatcher
Title
Cfo
Phone
(337) 494-2094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1525 Oak Park Blvd
Lake Charles, LA 70601-8849

Mailing address

PO Box 123453, Dept 3453
Dallas, TX 75312-0001
Phone (337) 494-2921

Other identifiers 1

IdentifierTypeStateIssuer
1947865MedicaidLA

Other names 1

  • LSUHSC Family Practice Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040702000045 LA Part B Supplier - Clinic/Group Practice 0042297558 Receives reassigned benefits from 12 practitioners
Practice locations: Lake Charles, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1073514493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123453, DEPT 3453",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 OAK PARK BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018849",
            "telephone_number": "337-494-6767",
            "fax_number": "337-494-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LSUHSC FAMILY PRACTICE CENTER @ LCMH",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-HATCHER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-494-2094"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1947865",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LSUHSC Family Practice Center",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "LSUHSC Family Practice Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.