Mackenzie Rae Gauthier
Individual provider Active NPI Physician Assistant · Jeanerette, LA
NPI 1124802525 · NPPES record last updated Aug 24, 2023
Key facts
- NPI
- 1124802525
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 1409 Church St
Jeanerette, LA 70544-4407 - Phone
- (337) 276-6018
- NPI assigned
- Aug 24, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Louisiana Gastroenterology Associates LLC
Practice addresses (Care Compare)
1211 Coolidge Blvd
Suite 303
Lafayette, LA 70503-2636
Phone (337) 232-6697
Hospital & facility affiliations
- Our Lady of Lourdes Regional Medical Center, Inc
- Ochsner Lafayette General Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240102002706 | LA | Practitioner - Physician Assistant | 3971953043 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Interoperability endpoints
- mgauthier5268022@direct.casso.us.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
1409 Church St
Jeanerette, LA 70544-4407
Mailing address
3710 Highway 457
Alexandria, LA 71302-9293
Other providers in Jeanerette, LA
- Eternal Handhome Care
- Ferguson Abundant Living Medical Transportation LLC
- Deirdre Faye Fontenot
- Terry Allen Frederick
- Treynell Frederick
- Gideon Healthcare Management LLC
- Deidra M Grogan
- Hospital Service District No. 1 of Iberia Parish
- Jaba Enterprises, Inc
- James Falterman, MD, AMC
All providers in Jeanerette, LA · Physician Assistant in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.