Our Lady of the Lake Physician Group LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

OUR LADY OF THE LAKE PHYSICIAN GROUP LLC

Practice address

230 Roberts Dr
Suite H
New Roads, LA 70760-2661

Phone

(225) 638-7033

Fax

(225) 638-7034

NPI assigned

Feb 6, 2007

Organization subpart

Yes

Parent organization

OUR LADY OF THE LAKE HOSPITAL INCAs reported in NPPES

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

Authorized official

Name

Elona Sharbaugh

Title

VP Physician Practices

Phone

(225) 490-8806

Specialties & licenses 2

Addresses

Other identifiers 1

Tax ID family

Our Lady of the Lake Physician Group LLC5 organizations share this tax ID, including this one

Part of

Industrial Family Medic

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Leo Blaize III MD

  dba Lake Internal Medicine at Hennessy

  • Non-Pharmacy Dispensing Site
  • Baton Rouge, LA
  • NPI 1952475311
  NPD tax ID
• Our Lady of the Lake Hospital Inc

  dba Lake Primary Care Physicians

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1275577603
  NPD tax ID
• Our Lady of the Lake Physician Group LLC

  • Family Medicine Physician
  • New Roads, LA
  • NPI 1356480214
  NPD tax ID
• Our Lady of the Lake Physician Group LLC

  • Family Medicine Physician
  • New Roads, LA
  • NPI 1518006568
  NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Our Lady of the Lake Hospital, Inc.

  dba Our Lady of the Lake Regional Medical Center

  • Psychiatric Hospital Unit
  • Baton Rouge, LA
  • NPI 1164419198

  Member Of

  NPD member
• Franciscan Missionaries of Our Lady Health System Inc

  dba RxONE St Dominic

  • Pharmacy
  • Jackson, MS
  • NPI 1932892601

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355097600000",
    "number": "1174662035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 SILVERSIDE DR",
            "address_2": "SUITE 120",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089005",
            "telephone_number": "225-765-4226",
            "fax_number": "225-765-9244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 ROBERTS DR",
            "address_2": "SUITE H",
            "city": "NEW ROADS",
            "state": "LA",
            "postal_code": "707602661",
            "telephone_number": "225-638-7033",
            "fax_number": "225-638-7034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF THE LAKE PHYSICIAN GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUR LADY OF THE LAKE HOSPITAL INC",
        "enumeration_date": "2007-02-06",
        "last_updated": "2012-12-10",
        "status": "A",
        "authorized_official_last_name": "SHARBAUGH",
        "authorized_official_first_name": "ELONA",
        "authorized_official_title_or_position": "VP PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "225-490-8806"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447501",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• New Roads Family Practice LLC
• Northland Hearing Centers, Inc. (Audibel Hearing Healthcare)
• Nurturing Seed Consulting LLC
• Myra Odom-Betz, MHS
• Jacklyn Olinde, PHARM.D.
• Our Lady of the Lake Physician Group LLC
• Our Lady of the Lake Physician Group LLC
• Our Lady of the Lake Physician Group LLC
• Alaina Ourso, RN
• Richard Gerard Palecki, D.P.M.

• Family Medicine Physician in New Roads, LA
• Providers in New Roads, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.