NPIMap

Individual provider Active NPI

Ellendale Withers Gabbert, C-FNP

  • Family Nurse Practitioner
  • Lake Charles, LA
National Provider Identifier
1134337017
Registry record updated Mar 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
63422-3267 Issued in LA
Practice address
501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone
(337) 433-8400
Fax
(337) 312-6711
NPI assigned
May 21, 2007
Last updated
Mar 21, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2017

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 63422-3267 LA Primary

Addresses

Primary practice location

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724

Mailing address

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 312-8258

Other identifiers 1

IdentifierTypeStateIssuer
1557773MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110913000394 LA Practitioner - Nurse Practitioner 6901847474 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imperial Health LLPGroup PAC ID 7719886779, 75 clinicians

Practice addresses (Care Compare)

250 S Beglis Pkwy
Suite 1
Sulphur, LA 70663-3503
Phone (337) 626-2529

277N Hwy 171
Suite 8
Lake Charles, LA 70611-5374
Phone (337) 312-0030

4201 Nelson Rd
Suite 100
Lake Charles, LA 70605-4117
Phone (337) 310-2273

501 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 433-8400

501 Shirley St
Deridder, LA 70634-3859
Phone (337) 202-7850

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63422-3267LAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health, LLP CurrentSince Sep 7, 2011 Accepting new patients
Imperial Health LLP CurrentSince Sep 7, 2011 Accepting new patients
Sulphur Emergency Group LLC Nurse Practitioner Past Accepting new patients

Locations

501 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8258

921 1st Ave
Sulphur, LA 70663
Phone (337) 527-2491

Interoperability endpoints

  • Direct secure messaging: ellendale.gabbert@1288.direct.myezyaccess.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1134337017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-312-8258",
            "fax_number": "337-312-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-433-8400",
            "fax_number": "337-312-6711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GABBERT",
        "first_name": "ELLENDALE",
        "middle_name": "WITHERS",
        "name_prefix": "Mrs.",
        "credential": "C-FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "LA",
            "license": "63422-3267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1557773",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.