NPIMap

Organization Active NPI

Pathology Group of Louisiana, a Professional Medical Corporation

  • Anatomic Pathology & Clinical Pathology Physician
  • Baton Rouge, LA
National Provider Identifier
1093843450
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION
Practice address
5339 O'Donovan Drive
Baton Rouge, LA 70808
Phone
(225) 766-4999
Fax
(225) 763-5870
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Authorized official

Name
Janna M Dietel
Title
Credentialing Specialist
Phone
(225) 706-0513

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Blood Banking & Transfusion Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZB0001X
Cytopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZC0500X
Dermatopathology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZD0900X
Hematology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZH0000X
Immunopathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZI0100X
Medical Microbiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZM0300X
Neuropathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZN0500X
Molecular Genetic Pathology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0007X
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X Primary
Pediatric Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0213X

Addresses

Primary practice location

5339 O'Donovan Drive
Baton Rouge, LA 70808

Mailing address

PO Box 84030
Baton Rouge, LA 70884-4030
Phone (225) 766-4999

Other identifiers 1

IdentifierTypeStateIssuer
1184781MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040514000007 LA Part B Supplier - Clinic/Group Practice 6507856317 Receives reassigned benefits from 29 practitioners
Practice locations: Baton Rouge, LA
O20051028000002 LA Part B Supplier - Independent Clinical Laboratory 6507856317 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0462633Pathology Group of Louisiana5339 O Donovan Drive, Baton Rouge, LA 70808AccreditationJan 2, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1093843450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84030",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708844030",
            "telephone_number": "225-766-4999",
            "fax_number": "225-763-5870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5339 O'DONOVAN DRIVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70808",
            "telephone_number": "225-766-4999",
            "fax_number": "225-763-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "DIETEL",
        "authorized_official_first_name": "JANNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "225-706-0513"
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZC0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Cytopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Hematology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZI0100X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Immunopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZM0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Medical Microbiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZN0500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Neuropathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0007X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Molecular Genetic Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0213X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Pediatric Pathology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184781",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.