NPIMap

Organization Active NPI

Pediatric Group of Acadiana, LLC

  • Specialist
  • Lafayette, LA
National Provider Identifier
1265499628
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PEDIATRIC GROUP OF ACADIANA, LLC
Practice address
401 Youngsville Hwy
Suite 100
Lafayette, LA 70508-5173
Phone
(337) 330-0031
Fax
(337) 735-3059
NPI assigned
Apr 28, 2006
Last updated
Dec 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Antoinette Rabenaldt
Title
Credentialing Coordinator
Phone
(337) 330-2576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

401 Youngsville Hwy
Suite 100
Lafayette, LA 70508-5173

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
1440604MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060123000121 LA Part B Supplier - Clinic/Group Practice 2466476023 Receives reassigned benefits from 33 practitioners
1 other NPI on this enrollment
Practice locations: Carencro, LA; Lafayette, LA; New Iberia, LA; Saint Martinville, LA; Scott, LA

Other NPIs with the same Medicare PAC ID 7

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0978940Pediatric Group of Acadiana401 Youngsville Highway, Ste 100, Lafayette, LA 70508AccreditationJul 24, 2028

National Provider Directory

National Provider Directory

Locations

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

426 Charles St
New Iberia, LA 70560
Phone (337) 365-4156

120 N Carolina St
New Roads, LA 70760
Phone (225) 638-8449

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

Ownership & related parties

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
St. Martinville Maternal-Child and Adult ClinicSaint Martinville, LA, CCN 193885 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 9, 2008
Pediatric Group of Acadiana & Family ClinicErath, LA, CCN 193925 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2001
Pediatric Group of Acadiana & Church Point ClinicChurch Point, LA, CCN 193944 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 9, 2008
Waterway PediatricsMaurepas, LA, CCN 193949 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 9, 2008
Oxbow Family PracticeNew Roads, LA, CCN 193948 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 9, 2008
Kids Clinic and Adult Wellness of CrowleyCrowley, LA, CCN 193964 Rural health clinic 5% Or Greater Direct Ownership Interest Jan 9, 2008

Owned or controlled facilities with NPI records 6

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

Practitioners & affiliated clinicians

Practitioners 54

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 54

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1265499628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 YOUNGSVILLE HWY",
            "address_2": "SUITE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085173",
            "telephone_number": "337-330-0031",
            "fax_number": "337-330-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 YOUNGSVILLE HWY",
            "address_2": "SUITE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085173",
            "telephone_number": "337-330-0031",
            "fax_number": "337-735-3059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC GROUP OF ACADIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "RABENALDT",
        "authorized_official_first_name": "ANTOINETTE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "337-330-2576"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1440604",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.