NPIMap

Individual provider Active NPI

Mark Anthony Portacci, MD

  • Family Medicine Physician
  • Oak Grove, LA
National Provider Identifier
1265500490
Registry record updated Feb 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0015833 Issued in LA
Practice address
706 Ross Street
Oak Grove, LA 71263
Phone
(318) 428-3237
Fax
(318) 428-6180
NPI assigned
Dec 4, 2006
Last updated
Feb 11, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 11, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0015833 LA Primary

Addresses

Primary practice location

706 Ross Street
Oak Grove, LA 71263

Mailing address

706 Ross Street
Oak Grove, LA 71263
Phone (318) 428-3237

Other identifiers 1

IdentifierTypeStateIssuer
1330957MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081229000508 LA Practitioner - Family Practice 5193887156 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Tulane University School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Louisiana Family Medicine Clinic 1Group PAC ID 4183889009, 3 clinicians

Practice addresses (Care Compare)

103 Watts St
Jonesboro, LA 71251-2053
Phone (318) 259-1569

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0015833LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
West Carroll Health Systems LLC CurrentSince Jan 19, 2011 Accepting new patients
West Carroll Health Systems LLC CurrentSince Jan 19, 2011 Accepting new patients
Louisiana Family Medicine Clinic 1 CurrentSince Jan 11, 2016 Accepting new patients
Forest Haven Nursing & Rehabilitation Center, LLC Past Accepting new patients
Hope Hospice, LLC Family Medicine Past Accepting new patients
River Healthcare, Inc Family Medicine Past Accepting new patients

Locations

2890 Douglas Dr
Ste 110
Bossier City, LA 71111

103 Watts St
Jonesboro, LA 71251
Phone (318) 259-1569

706 Ross St
Oak Grove, LA 71263
Phone (318) 428-3237

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Acg HospiceJonesboro, LA, CCN 191577 Hospice Contracted Managing Employee Feb 20, 2022

Owned or controlled facilities with NPI records 1

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

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234310400000",
    "number": "1265500490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 ROSS STREET",
            "city": "OAK GROVE",
            "state": "LA",
            "postal_code": "71263",
            "telephone_number": "318-428-3237",
            "fax_number": "318-428-6180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 ROSS STREET",
            "city": "OAK GROVE",
            "state": "LA",
            "postal_code": "71263",
            "telephone_number": "318-428-3237",
            "fax_number": "318-428-6180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTACCI",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2009-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "0015833",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1330957",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Grove, LA

Sources for this page

Verify at the official NPI Registry.