Individual provider Active NPI

Mandy Braud Grier, M.D.

  • Pediatrics Physician
  • Baton Rouge, LA
National Provider Identifier
1235138355
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
200331 Issued in LA
Practice address
12525 Perkins Rd
Suite C
Baton Rouge, LA 70810-1907
Phone
(225) 769-2003
Fax
(225) 767-3055
NPI assigned
Jul 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 200331 LA Primary

Addresses

Primary practice location

12525 Perkins Rd
Suite C
Baton Rouge, LA 70810-1907

Mailing address

12525 Perkins Rd
Suite C
Baton Rouge, LA 70810-1907
Phone (225) 769-2003

Other identifiers 1

IdentifierTypeStateIssuer
1628271MedicaidLA

Other names 1

  • Mandy Lynn Braud Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mgrier2616@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

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
I20071031000494 LA Practitioner - Pediatric Medicine 9032206578 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
200331LAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC CurrentSince Jul 1, 2012 Accepting new patients
Our Lady of the Lake Physician Group LLC Pediatrics CurrentSince Jul 1, 2012 Accepting new patients
Our Lady of the Lake Hospital Inc Pediatrics Past Accepting new patients
Our Lady of the Lake Physician Group LLC Past Accepting new patients

Locations

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

12525 Perkins Rd
#C
Baton Rouge, LA 70810
Phone (225) 768-8103

8300 Constantin Blvd
Baton Rouge, LA 70809
Phone (225) 374-1410

1937 S Burnside Ave
Gonzales, LA 70737
Phone (225) 647-1947

18989 Old Scenic Hwy
Zachary, LA 70791
Phone (225) 654-6140

Interoperability endpoints

  • Direct secure messaging: mgrier2616@direct.casso.us.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1235138355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12525 PERKINS RD",
            "address_2": "SUITE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708101907",
            "telephone_number": "225-769-2003",
            "fax_number": "225-767-3055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12525 PERKINS RD",
            "address_2": "SUITE C",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708101907",
            "telephone_number": "225-769-2003",
            "fax_number": "225-767-3055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIER",
        "first_name": "MANDY",
        "middle_name": "BRAUD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "200331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1628271",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgrier2616@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "mgrier2616@direct.casso.us.com",
            "address_1": "12525 Perkins Rd",
            "address_2": "Suite C",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708101907",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C=CDA",
            "address_1": "12525 Perkins Rd",
            "address_2": "Suite C",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708101907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MANDY",
            "last_name": "BRAUD",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.