NPIMap

Individual provider Active NPI

Mark Christian Mouton, M.D.

  • Internal Medicine Physician
  • Baker, LA
National Provider Identifier
1164613758
Registry record updated Jun 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD.201233 Issued in LA
Practice address
12880 Plank Rd
Baker, LA 70714-4909
Phone
(225) 774-7111
Fax
(225) 774-7111
NPI assigned
Aug 7, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 29, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD.201233 LA Primary

Addresses

Primary practice location

12880 Plank Rd
Baker, LA 70714-4909

Mailing address

12880 Plank Rd
Baker, LA 70714-4909
Phone (225) 774-7111

Other identifiers 1

IdentifierTypeStateIssuer
1090484MedicaidLA

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
I20081204000975 LA Practitioner - Internal Medicine 8426119736 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark C Mouton MD LLCGroup PAC ID 5597816207, 4 clinicians

Practice addresses (Care Compare)

12880 Plank Rd
Baker, LA 70714-4909
Phone (225) 774-7111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy18
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue14
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD.201233LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lsuhn Billing LLC Past Accepting new patients
Zachary Manor Nursing & Rehabilitation Center LLC Past Accepting new patients
Community Care Center of Heritage House LLC Past Accepting new patients
LTAC Hospital of Feliciana, LLC Past Accepting new patients
Lsuhn Billing LLC PastSince Mar 17, 2024 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Zachary - Amg Specialty HospitalZachary, LA, CCN 192041 Hospital 5% Or Greater Direct Ownership Interest (11.76%) Jan 1, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404000000000",
    "number": "1164613758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12880 PLANK RD",
            "city": "BAKER",
            "state": "LA",
            "postal_code": "707144909",
            "telephone_number": "225-774-7111",
            "fax_number": "225-774-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12880 PLANK RD",
            "city": "BAKER",
            "state": "LA",
            "postal_code": "707144909",
            "telephone_number": "225-774-7111",
            "fax_number": "225-774-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUTON",
        "first_name": "MARK",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-07",
        "last_updated": "2014-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "MD.201233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1090484",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baker, LA

Sources for this page

Verify at the official NPI Registry.