Active NPI
Jason P Hagen, M.D.
- Family Medicine Physician
- Lake Charles, LA
National Provider Identifier
1093008401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD205679
- Practice address
- 1000 Walters St
Lake Charles, LA 70607-4647 - Phone
- (337) 480-8066
- Fax
- (337) 480-8061
- NPI assigned
- May 17, 2011
- Last updated
- Apr 27, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 205679 | LA | |
| Family Medicine Physician | 207Q00000X | MD205679 | LA | Primary |
Addresses
Primary practice location
1000 Walters St
Lake Charles, LA 70607-4647
Mailing address
PO Box 122108 Dept 2108
Dallas, TX 75312-0001
Phone (337) 494-2921
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD.205679 | Other | LA | STATE LICENSE |
| 2150383 | Medicaid | LA |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Louisiana State University School of Medicine in Shreveport, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1701 Oak Park Blvd
Lake Charles, LA 70601-8911
Phone (337) 494-3036
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD205679 | LA | MD | Family Medicine Physician |
| 205679 | LA | MD | Primary Care Clinic/Center |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Professional Emergency Medicine Management -- Lake Charles LLC | Current | Accepting new patients | |
| Concord Medical Group PLLC | Current | Accepting new patients | |
| South Central Physicians PLLC | Current | Accepting new patients | |
| Concord Medical Group of Texas PLLC | Current | Accepting new patients |
Locations
600 S Pine St
Deridder, LA 70634
Phone (337) 462-7100
165 Beech Springs Rd
Jonesboro, LA 71251
Phone (318) 259-4435
1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000
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.
-
- Emergency Medicine Physician
- Lake Charles, LA
- NPI 1023430766
-
- Emergency Medicine Physician
- Lubbock, TX
- NPI 1750790762
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Digestive Health Center of SWLA
- Gastroenterology Physician
- Lake Charles, LA
- NPI 1285351411
Hospital
-
dba Rheumatology Associates
- Rheumatology Physician
- Lake Charles, LA
- NPI 1659424075
Hospital
-
dba Lake Charles Memorial Hospital
- General Acute Care Hospital
- Lake Charles, LA
- NPI 1972549855
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651017600000",
"number": "1093008401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 122108 DEPT 2108",
"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": "1000 WALTERS ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706074647",
"telephone_number": "337-480-8066",
"fax_number": "337-480-8061"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEN",
"first_name": "JASON",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-17",
"last_updated": "2022-04-27",
"certification_date": "2022-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "261QP2300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Primary Care",
"state": "LA",
"license": "205679",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "LA",
"license": "MD205679",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "MD.205679",
"state": "LA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2150383",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}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 Apr 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; 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.