Individual provider Active NPI

Lesley Reviere Ott, NP

  • Family Nurse Practitioner
  • Baton Rouge, LA
National Provider Identifier
1124603154
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
218811 Issued in LA
Practice address
6411 Perkins Rd Ste 100
Baton Rouge, LA 70808-4125
Phone
(225) 303-9500
NPI assigned
Mar 11, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 218811 LA Primary

Addresses

Primary practice location

6411 Perkins Rd Ste 100
Baton Rouge, LA 70808-4125

Mailing address

12581 Three Lakes Dr
Walker, LA 70785-8214
Phone (337) 580-2064

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210414000321 LA Practitioner - Nurse Practitioner 1052729951 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Derma LLCGroup PAC ID 5395270938, 3 clinicians

Practice addresses (Care Compare)

6411 Perkins Rd
Suite 202
Baton Rouge, LA 70808-5193
Phone (225) 800-6869

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
218811LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dermasurgery Center, LLC CurrentSince Apr 1, 2021 Accepting new patients
Derma LLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

6411 Perkins Rd
Ste 100
Baton Rouge, LA 70808
Phone (225) 303-9500

6411 Perkins Rd
Ste 202
Baton Rouge, LA 70808
Phone (225) 800-6869

1245 Camellia Blvd
Ste 300
Lafayette, LA 70508
Phone (337) 839-2773

701 Metairie Rd
Ste 2A205
Metairie, LA 70005
Phone (504) 836-2050

Interoperability endpoints

  • Direct secure messaging: lott@sanovaderm.emadirect.md

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": "1615420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1124603154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12581 THREE LAKES DR",
            "city": "WALKER",
            "state": "LA",
            "postal_code": "707858214",
            "telephone_number": "337-580-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6411 PERKINS RD STE 100",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084125",
            "telephone_number": "225-303-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTT",
        "first_name": "LESLEY",
        "middle_name": "REVIERE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-11",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "218811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.