Our Lady of the Lake Physician Group LLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

OUR LADY OF THE LAKE PHYSICIAN GROUP LLC

Doing business as

Our Lady of the Lake Children's Health Developmental Center at McMains

Practice address

1805 College Dr
Baton Rouge, LA 70808-1919

Phone

(225) 923-3420

Fax

(225) 922-9316

NPI assigned

Aug 18, 2023

Last updated

Aug 18, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

OUR LADY OF THE LAKE PHYSICIAN GROUP LLCAs reported in NPPES

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

Authorized official

Name

Jamy Richard

Title

VP of Finance

Phone

(225) 526-0121

Specialties & licenses 1

Addresses

Other names 1

• Our Lady of the Lake Children's Health Developmental Center at McMains Doing business as

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

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

• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943

  O20120529000377

  Same enrollment
• Our Lady of the Lake Physician Group, LLC

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1588062079

  O20120529000377

  Same enrollment

Tax ID family

Olol Physician Group LLC5 organizations share this tax ID, including this one

Part of

Olol Physician Group LLC

Other organizations with this tax ID 4

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

• Our Lady of the Lake Physician Group LLC

  • Family Medicine Physician
  • New Roads, LA
  • NPI 1447399308
  NPD tax ID
• Our Lady of the Lake Physician Group LLC

  dba Pediatric Emergency Services

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Baton Rouge, LA
  • NPI 1912282831
  NPD tax ID
• Our Lady of the Lake Physician Group, LLC

  • Rural Health Clinic/Center
  • Maurepas, LA
  • NPI 1134152630
  NPD tax ID
• Our Lady of the Lake Physician Group, LLC

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1972052520
  NPD tax ID

Member of 2

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

• Franciscan Missionaries of Our Lady Health System Inc

  dba RxONE Lourdes

  • Community/Retail Pharmacy
  • Lafayette, LA
  • NPI 1518572049

  Member Of

  NPD member
• 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

Locations (25 of 40)

Practitioners 925

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.

• Kimberly Ann Abbott, N.P.

  • Family Nurse Practitioner
  • Prairieville, LA
  • NPI 1740203041
  NPD
• Mostafa Aboubakr, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Baton Rouge, LA
  • NPI 1841713427
  NPD
• Niksad Abraham, MD

  • Cardiovascular Disease Physician
  • Gonzales, LA
  • NPI 1033246970
  NPD
• Shaun A Abraham, M.D.

  • Hospitalist Physician
  • Baton Rouge, LA
  • NPI 1174883722
  NPD
• Natalie Viator Abshier, PA

  • Physician Assistant
  • Baton Rouge, LA
  • NPI 1144614017
  NPD
• Shaun Ian Accardo, M.D.

  • Orthopaedic Surgery Physician
  • Baton Rouge, LA
  • NPI 1104140755
  NPD
• Joseph A Acosta, MD

  • Neurology Physician
  • Baton Rouge, LA
  • NPI 1710976915
  NPD
• Michael Clay Adamek, MD

  • Hospitalist Physician
  • Baton Rouge, LA
  • NPI 1780145342
  NPD
• Alyce R. Adams, M.D.,CDE

  • Internal Medicine Physician
  • West Monroe, LA
  • NPI 1700806767
  NPD
• Stephen Adjei, M.D.

  • Critical Care Medicine (Internal Medicine) Physician
  • Baton Rouge, LA
  • NPI 1871518530
  NPD
• Lacey Katherine Adkins, MD

  • Otolaryngology Physician
  • Baton Rouge, LA
  • NPI 1972893816
  NPD
• Jose L Aguayo Herrera, MD

  • Hospitalist Physician
  • Baton Rouge, LA
  • NPI 1205569548
  NPD

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692316800000",
    "number": "1235912502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 677957",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752677957",
            "telephone_number": "225-765-5727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 COLLEGE DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708081919",
            "telephone_number": "225-923-3420",
            "fax_number": "225-922-9316"
        }
    ],
    "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 PHYSICIAN GROUP LLC",
        "enumeration_date": "2023-08-18",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A",
        "authorized_official_last_name": "RICHARD",
        "authorized_official_first_name": "JAMY",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "225-526-0121"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Our Lady of the Lake Children's Health Developmental Center at McMains",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Our Lady of the Lake Hospital, Inc. (Our Lady of the Lake Regional Medical Center Skilled Nursing Facility)
• Our Lady of the Lake Inc (Hospital Medicine Service)
• Our Lady of the Lake Oral Surgery Clinic
• Our Lady of the Lake Physician Group LLC
• Our Lady of the Lake Physician Group LLC (OLOL Physician Surgical Specialty)
• Our Lady of the Lake Physician Group LLC (Lake Physician Group Cardiology Ser)
• Our Lady of the Lake Physician Group LLC (Pediatric Emergency Services)
• Our Lady of the Lake Physician Group, LLC
• Our Lady of the Lake Physician Group, LLC
• Our Lady of the Lake Plastic Clinic (Our Lady of the Lake Regional Medical Center)

• Comprehensive Outpatient Rehabilitation Facility (CORF) in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; 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.