NPIMap

Organization Active NPI

Camellia City Obstetrics and Gynecology

  • Obstetrics & Gynecology Physician
  • Slidell, LA
National Provider Identifier
1184634040
Registry record updated Feb 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
90577 Issued in LA
Legal business name
CAMELLIA CITY OBSTETRICS AND GYNECOLOGY
Practice address
1150 Robert Blvd
Suite 360
Slidell, LA 70458-2004
Phone
(985) 781-4848
Fax
(985) 781-4850
NPI assigned
Aug 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2011

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

Authorized official

Name
Dr. Diana Clavin, MDNPI 1669463915
Title
Authorized Agent
Phone
(985) 781-4848

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 90577 LA Primary

Addresses

Primary practice location

1150 Robert Blvd
Suite 360
Slidell, LA 70458-2004

Mailing address

1150 Robert Blvd
Suite 360
Slidell, LA 70458-2004
Phone (985) 781-4848

Other identifiers 3

IdentifierTypeStateIssuer
2113381MedicaidLA
5U504DS23OtherLAMEDICARE LA LINKING NO. - ANN R. LOBELLO, MD
5W897DS23OtherLAMEDICARE LA LINKING NO. DIANA K. CLAVIN, MD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110216000679 LA Part B Supplier - Clinic/Group Practice 9638350143 Receives reassigned benefits from 3 practitioners
Practice locations: Slidell, LA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0964187Camellia City Obstetrics & Gynecology, LLC1150 Robert Boulevard, Suite 220, Slidell, LA 70458Provider-performed microscopyDec 20, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298505600000",
    "number": "1184634040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 ROBERT BLVD",
            "address_2": "SUITE 360",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582004",
            "telephone_number": "985-781-4848",
            "fax_number": "985-781-4850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 ROBERT BLVD",
            "address_2": "SUITE 360",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582004",
            "telephone_number": "985-781-4848",
            "fax_number": "985-781-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMELLIA CITY OBSTETRICS AND GYNECOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-09",
        "last_updated": "2011-02-24",
        "status": "A",
        "authorized_official_last_name": "CLAVIN",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "985-781-4848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "LA",
            "license": "90577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2113381",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LA LINKING NO. - ANN R. LOBELLO, MD",
            "identifier": "5U504DS23",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LA LINKING NO. DIANA K. CLAVIN, MD",
            "identifier": "5W897DS23",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.