NPIMap

Organization Active NPI

Baton Rouge General Primary Care, LLC

  • Family Medicine Physician
  • Baton Rouge, LA
National Provider Identifier
1114356979
Registry record updated Dec 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BATON ROUGE GENERAL PRIMARY CARE, LLC
Practice address
5353 Florida Blvd
Baton Rouge, LA 70806-4130
Phone
(225) 367-4558
Fax
(225) 367-4576
NPI assigned
Nov 2, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2018

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

Authorized official

Name
Kendall Johnson
Title
C.F.O.
Phone
(225) 237-1645

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X

Addresses

Primary practice location

5353 Florida Blvd
Baton Rouge, LA 70806-4130

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1114356979OtherNPPES
1443328MedicaidLA

Other names 1

  • PRIMARY CARE GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120109000384 LA Part B Supplier - Clinic/Group Practice 3779759030 Receives reassigned benefits from 7 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA

Other NPIs on the same Medicare enrollment 3

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
19D1013396Primary Care Group5353 Florida Blvd, Baton Rouge, LA 70806Certificate of waiverJun 8, 2027

National Provider Directory

National Provider Directory

Locations

3401 N Blvdste 130
New Orleans, LA 70154

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545782400000",
    "number": "1114356979",
    "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": "5353 FLORIDA BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708064130",
            "telephone_number": "225-367-4558",
            "fax_number": "225-367-4576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATON ROUGE GENERAL PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-02",
        "last_updated": "2018-12-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_title_or_position": "C.F.O.",
        "authorized_official_telephone_number": "225-237-1645"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1114356979",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1443328",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIMARY CARE GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRIMARY CARE GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 26, 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.