Our Lady of the Lake Physician Group LLC
Organization Active NPI Comprehensive Outpatient Rehabilitation Facility (CORF) · Baton Rouge, LA
NPI 1235912502 · NPPES record last updated Aug 18, 2023
Key facts
- NPI
- 1235912502
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X
- Legal business name
- OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
- Practice address
- 1805 College Dr
Baton Rouge, LA 70808-1919 - Phone
- (225) 923-3420
- Fax
- (225) 922-9316
- NPI assigned
- Aug 18, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Authorized official
- Name
- Jamy Richard
- Title
- VP of Finance
- Phone
- (225) 526-0121
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 4
Practitioners 925
-
Kimberly Ann Abbott, N.P.
-
Mostafa Aboubakr, MD
-
Niksad Abraham, MD
-
Shaun A Abraham, M.D.
-
Shaun Ian Accardo, M.D.
-
Joseph A Acosta, MD
-
Alyce R. Adams, M.D.,CDE
-
Stephen Adjei, M.D.
-
Paul Cary Aguillard, M.D.
-
Rasheed I Ahmad, M.D.
-
Stephanie Akunne, NP
-
Joel Alack, MD
-
Kyle M Alain, PA
-
Shafaqat Ali, MD
-
Brent Wheeler Allain Jr., M.D.
-
Clinton Joseph Alombro, M.D.
-
Elizabeth Alonso, MD
-
John Pierre Amadon, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120529000377 | LA | Part B Supplier - Clinic/Group Practice | 4587849781 |
Receives reassigned benefits from 978 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Our Lady of the Lake Physician Group LLC
- Part of
- Our Lady of the Lake Physician Group LLC
Locations (25 of 37)
8119 Picardy Ave
Ste B
Baton Rouge, LA 70809
Phone (225) 215-5980
4950 Essen Ln
Ste 500
Baton Rouge, LA 70809
Phone (225) 765-8823
7777 Hennessy Blvd
Ste 302
Baton Rouge, LA 70808
Phone (225) 374-0500
5131 Odonovan Dr
Ste 301
Baton Rouge, LA 70808
Phone (225) 490-0393
7555 Bishop Ott Dr
Baton Rouge, LA 70806
Phone (225) 926-5918
11424 Sullivan Rd
#A-C
Baton Rouge, LA 70818
Phone (225) 261-7021
5131 Odonovan Dr
Ste 300
Baton Rouge, LA 70808
Phone (225) 374-0400
8300 Constantin Blvd
Fl 3
Baton Rouge, LA 70809
Phone (225) 374-1485
8200 Constantin Blvd
Ste 210
Baton Rouge, LA 70809
Phone (225) 374-4985
1805 College Dr
Baton Rouge, LA 70808
Phone (225) 923-3420
500 Rue de la Vie St
Ste 430
Baton Rouge, LA 70817
Phone (225) 214-6700
13702 Coursey Blvd
Ste Ab
Baton Rouge, LA 70817
Phone (225) 756-4100
8415 Goodwood Blvd
Ste 205
Baton Rouge, LA 70806
Phone (225) 765-7735
18180 Jefferson Hwy
Baton Rouge, LA 70817
Phone (225) 291-8474
5428 Stumberg Ln
Ste A
Baton Rouge, LA 70816
Phone (225) 756-4100
8415 Goodwood Blvd
Ste 202B
Baton Rouge, LA 70806
Phone (225) 765-8988
4550 Government St
Baton Rouge, LA 70806
70411 Highway 21
Covington, LA 70433
Phone (985) 288-5088
2647 S Saint Elizabeth Blvd
Ste 311
Gonzales, LA 70737
Phone (225) 743-2833
1937 S Burnside Ave
Gonzales, LA 70737
Phone (225) 647-1947
2647 S Saint Elizabeth Blvd
Ste 220
Gonzales, LA 70737
Phone (225) 743-2345
721 Highway 30
Gonzales, LA 70737
Phone (225) 644-7337
2647 S Saint Elizabeth Blvd
Ste 221
Gonzales, LA 70737
Phone (225) 289-6403
1024 E Ascension Complex Blvd
Gonzales, LA 70737
Phone (225) 644-2616
2647 S Saint Elizabeth Blvd
Ste 125
Gonzales, LA 70737
Phone (225) 647-9675
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Comprehensive Outpatient Rehabilitation Facility (CORF) | 261QR0401X | Yes |
Addresses
Primary practice location
1805 College Dr
Baton Rouge, LA 70808-1919
Mailing address
PO Box 677957
Dallas, TX 75267-7957
Phone (225) 765-5727
Other names
- Our Lady of the Lake Children's Health Developmental Center at McMains
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All providers in Baton Rouge, LA · Comprehensive Outpatient Rehabilitation Facility (CORF) in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.