Individual provider Active NPI

Amie Angelle Medeiros, OT

  • Hand Occupational Therapist
  • Lafayette, LA
National Provider Identifier
1104970235
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hand Occupational TherapistTaxonomy code 225XH1200X
License
OTT.200364 Issued in LA
Practice address
108 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone
(337) 889-3106
NPI assigned
Jan 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 111421 TX
Hand Occupational Therapist 225XH1200X OTT.200364 LA Primary

Addresses

Primary practice location

108 Rue Louis Xiv
Lafayette, LA 70508-5739

Mailing address

217 Summerland Key LN
Lafayette, LA 70508-5152
Phone (214) 929-9495

Other practice location 1

6020 W Parker Rd
Suite 230
Plano, TX 75093-8171
Phone (972) 608-5090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171117002670 LA Practitioner - Occupational Therapist in Private Practice 2163788530 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Louisiana Orthopaedic Specialists LLCGroup PAC ID 1850469305, 71 clinicians

Practice addresses (Care Compare)

108 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone (337) 889-3098

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OTT.200364LAMDHand Occupational Therapist
111421TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Louisiana Orthopaedic Specialists, LLC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1104970235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 SUMMERLAND KEY LN",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085152",
            "telephone_number": "214-929-9495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 RUE LOUIS XIV",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-889-3106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6020 W Parker Rd",
            "address_2": "Suite 230",
            "address_purpose": "LOCATION",
            "city": "Plano",
            "state": "TX",
            "postal_code": "750938171",
            "country_code": "US",
            "telephone_number": "972-608-5090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MEDEIROS",
        "first_name": "AMIE",
        "middle_name": "ANGELLE",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "111421",
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "LA",
            "license": "OTT.200364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.