NPIMap

Organization Active NPI

Pathology Group of Louisiana, a Professional Medical Corporation

  • Clinical Medical Laboratory
  • Baton Rouge, LA
National Provider Identifier
1194978122
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION
Practice address
5339 Odonovan Dr
Baton Rouge, LA 70808-4388
Phone
(225) 766-4999
Fax
(225) 763-5870
NPI assigned
Nov 4, 2008
Last updated
Jun 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Authorized official

Name
Janna M Barker
Title
Credentialing
Phone
(225) 706-0513

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU

Addresses

Primary practice location

5339 Odonovan Dr
Baton Rouge, LA 70808-4388

Mailing address

5339 Odonovan Dr
Baton Rouge, LA 70808-4388
Phone (225) 766-4999

Other identifiers 2

IdentifierTypeStateIssuer
1184781MedicaidLA
18336OtherLAMEDICARE INDEPENDANT LAB

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051028000002 LA Part B Supplier - Independent Clinical Laboratory 6507856317 1 other NPI on this enrollment
Practice locations: Baton Rouge, LA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pathology and Nuec Med2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

5339 Odonovan Dr
Baton Rouge, LA 70808
Phone (225) 766-4999

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1225756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1194978122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5339 ODONOVAN DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084388",
            "telephone_number": "225-766-4999",
            "fax_number": "225-764-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5339 ODONOVAN DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084388",
            "telephone_number": "225-766-4999",
            "fax_number": "225-763-5870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY GROUP OF LOUISIANA, A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-04",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "BARKER",
        "authorized_official_first_name": "JANNA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "225-706-0513"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184781",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDEPENDANT LAB",
            "identifier": "18336",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.