NPIMap

Individual provider Active NPI

Kenyatta D. Shamlin, M.D.

  • Internal Medicine Physician
  • Baton Rouge, LA
National Provider Identifier
1093712234
Registry record updated Sep 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
025911 Issued in LA
Practice address
8595 Picardy Ave
Ste 100
Baton Rouge, LA 70809-3674
Phone
(225) 763-4900
Fax
(225) 763-4938
NPI assigned
Jul 1, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 025911 LA
Internal Medicine Physician 207R00000X 025911 LA Primary

Addresses

Primary practice location

8595 Picardy Ave
Ste 100
Baton Rouge, LA 70809-3674

Mailing address

8490 Picardy Ave
BLDG 200
Baton Rouge, LA 70809-3731
Phone (225) 237-1754

Other practice location 1

7444 Picardy Ave Ste B
Baton Rouge, LA 70808-4331
Phone (225) 424-2554

Other identifiers 2

IdentifierTypeStateIssuer
110243989OtherLARAILROAD MEDICARE
1136247MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101020000040 LA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 8123128857 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Baylor College of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

7444 Picardy Ave
Baton Rouge, LA 70808-4331
Phone (225) 424-2554

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
025911LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Louisiana Internal Medicine and Pediatric Associates, LLC CurrentSince Aug 22, 2017 Accepting new patients
Our Lady of the Lake Physician Group LLC Past Accepting new patients

Locations

7444 Picardy Ave
Baton Rouge, LA 70808
Phone (225) 424-2554

7444 Picardy Ave
Ste B
Baton Rouge, LA 70808
Phone (225) 216-7885

Organizations & group practices 2

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 8

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": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1093712234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8490 PICARDY AVE",
            "address_2": "BLDG 200",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093731",
            "telephone_number": "225-237-1754",
            "fax_number": "225-237-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8595 PICARDY AVE",
            "address_2": "STE 100",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093674",
            "telephone_number": "225-763-4900",
            "fax_number": "225-763-4938"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7444 Picardy Ave Ste B",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708084331",
            "country_code": "US",
            "telephone_number": "225-424-2554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAMLIN",
        "first_name": "KENYATTA",
        "middle_name": "D.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-01",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "025911",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "025911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110243989",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1136247",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.