Individual provider Active NPI

Mark Lane Stephens, FNP-C

  • Family Nurse Practitioner
  • Monroe, LA
National Provider Identifier
1083992556
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN089763-AP06597 Issued in LA
Practice address
920 Oliver Rd
Monroe, LA 71201-5702
Phone
(318) 807-4713
Fax
(318) 807-1833
NPI assigned
Aug 1, 2011
Last updated
Jun 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN089763-AP06597 LA Primary

Addresses

Primary practice location

920 Oliver Rd
Monroe, LA 71201-5702

Mailing address

130 Desiard St
Suite 355
Monroe, LA 71201-7319
Phone (318) 807-7875

Other identifiers 1

IdentifierTypeStateIssuer
2174711MedicaidLA

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
I20120106000600 LA Practitioner - Nurse Practitioner 9335315647 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7373 Perkins Rd
Baton Rouge, LA 70808-4326
Phone (225) 246-9790

920 Oliver Rd
Monroe, LA 71201-5702
Phone (318) 998-3426

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as apm
Quality
60.04
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN089763-AP06597LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Health Group, LLC CurrentSince Nov 12, 2011 Accepting new patients
Baton Rouge Clinic, a Medical Corporation CurrentSince Oct 1, 2024 Accepting new patients
Affinity Health Group, LLC CurrentSince Nov 12, 2011 Accepting new patients
Baton Rouge Clinic, a Medical Corporation CurrentSince Oct 1, 2024 Accepting new patients

Locations

7373 Perkins Rd
Baton Rouge, LA 70808
Phone (225) 246-9790

130 Desiard St
Ste 355
Monroe, LA 71201
Phone (318) 807-7875

2408 Broadmoor Blvd
Ste 2
Monroe, LA 71201
Phone (318) 807-0525

2516 Broadmoor Blvd
Monroe, LA 71201
Phone (318) 322-1161

920 Oliver Rd
Monroe, LA 71201
Phone (318) 807-6267

920 Oliver Rd
#L
Monroe, LA 71201
Phone (318) 361-2161

Organizations & group practices 4

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

Hospital & facility affiliations 1

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": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1083992556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST",
            "address_2": "SUITE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017319",
            "telephone_number": "318-807-7875",
            "fax_number": "318-812-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 OLIVER RD",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015702",
            "telephone_number": "318-807-4713",
            "fax_number": "318-807-1833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "MARK",
        "middle_name": "LANE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-01",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "RN089763-AP06597",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2174711",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.