Courtney Vice Habetz, P.A.-C – Physician Assistant

Key facts

NPI: 1235268293
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: PA.200121 (LA)
Practice address: 1119 N Main St
Saint Martinville, LA 70582-3513
Phone: (337) 394-7774
Fax: (337) 394-8015
NPI assigned: Mar 5, 2007
Sex: Female
Sole proprietor: No

Organizations & group practices 3

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.

Pediatric Group of Acadiana, LLC Specialist · Lafayette, LA · NPI 1265499628

Medicare reassignment NPD (past) LA
Pediatric Group of Acadiana LLC Rural Health Clinic/Center · Kaplan, LA · NPI 1922619238

NPD
Pediatric Group of Acadiana, LLC Rural Health Clinic/Center · Saint Martinville, LA · NPI 1922283225

NPD

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Pediatric Group of Acadiana, LLC Rural Health Clinic/Center · Saint Martinville, LA · NPI 1922283225

CMS ownership W-2 MANAGING EMPLOYEE

Medicare participation

Medicare fee-for-service enrollment: Enrolled in LA
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Facility	Type	Role	Since
St. Martinville Maternal-Child and Adult Clinic Saint Martinville, LA · CCN 193885	Rural health clinic	W-2 Managing Employee	May 16, 2007

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20070912000757	LA	Practitioner - Physician Assistant	9638262207	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
PA.200121	LA	MD	Physician Assistant

Practice roles

Organization	Status	New patients
Pediatric Group of Acadiana, LLC	Current since Sep 29, 2016	Accepting new patients
Pediatric Group of Acadiana LLC	Current since Sep 29, 2016	Accepting new patients
Pediatric Group of Acadiana, LLC	Past	Accepting new patients

Locations

401 Youngsville Hwy
Ste 100
Lafayette, LA 70508
Phone (337) 330-0031

431 E Evergreen St
Lafayette, LA 70501
Phone (337) 806-9910

2308 E Main St
Ste G
New Iberia, LA 70560
Phone (337) 367-2001

1119 N Main St
St Martinvlle, LA 70582
Phone (337) 394-7774

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	PA.200121	LA	Yes

Addresses

Primary practice location

1119 N Main St
Saint Martinville, LA 70582-3513

Mailing address

401 Youngsville Hwy
Suite 100
Lafayette, LA 70508-5173
Phone (337) 330-0031

Other identifiers

Identifier	Type	State	Issuer
1407208	Medicaid	LA

Other providers in Saint Martinville, LA

All providers in Saint Martinville, LA · Physician Assistant in Louisiana

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
Provider of Services files (CMS): certification status, beds and related CCNs.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.