Individual provider Active NPI

Elizabeth Mortazavi, D.O.

  • Interventional Pain Medicine Physician
  • Thibodaux, LA
National Provider Identifier
1164956389
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
333030 Issued in LA
Practice address
602 N Acadia Rd
Thibodaux, LA 70301-4823
Phone
(985) 447-5500
NPI assigned
Apr 13, 2017
Last updated
Dec 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Interventional Pain Medicine Physician 208VP0014X 333030 LA Primary

Addresses

Primary practice location

602 N Acadia Rd
Thibodaux, LA 70301-4823

Mailing address

5251 Magazine St
New Orleans, LA 70115-1851
Phone (813) 495-4893

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220926003262 LA Practitioner - Pain Management 9133522758 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain Management
Education
Nova Southeastern College of Osteo Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

726 N Acadia Rd
Suite 2400
Thibodaux, LA 70301-5078
Phone (985) 493-4080

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.55 of 100Reported as group
Quality
67.62
Promoting interoperability
100
Improvement activities
40
Cost
71.34

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Thibodaux Regional Network Development Corporation CurrentSince Sep 26, 2022 Accepting new patients
Thibodaux Regional Network Development Corporation Current Accepting new patients
Thibodaux Regional Network Development Corporation CurrentSince Sep 26, 2022 Accepting new patients
Thibodaux Regional Network Development Corporation Past Accepting new patients

Locations

1238 Saint Charles St
Houma, LA 70360
Phone (985) 872-9430

4560 Highway 1
Ste 3
Raceland, LA 70394
Phone (985) 251-4250

602 N Acadia Rd
Thibodaux, LA 70301
Phone (985) 493-4544

726 N Acadia Rd
Ste 2400
Thibodaux, LA 70301
Phone (985) 493-4080

Interoperability endpoints

  • Direct secure messaging: elizabeth.mortazavi@direct.thibodaux.la-hie.org

Organizations & group practices 4

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 1

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": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1164956389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5251 MAGAZINE ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701151851",
            "telephone_number": "813-495-4893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 N ACADIA RD",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703014823",
            "telephone_number": "985-447-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTAZAVI",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-13",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "LA",
            "license": "333030",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thibodaux, LA

Sources for this page

Verify at the official NPI Registry.