Individual provider Active NPI

Dustin Lane Chapman Hadley, PA-C

  • Physician Assistant
  • Shreveport, LA
National Provider Identifier
1275051229
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
3217 Mabel St
Shreveport, LA 71103-4022
Phone
(318) 631-9121
Fax
(318) 631-9126
NPI assigned
Aug 30, 2017
Last updated
Aug 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X LA Primary

Addresses

Primary practice location

3217 Mabel St
Shreveport, LA 71103-4022

Mailing address

3217 Mabel St
Shreveport, LA 71103-4022
Phone (318) 631-9121

Other identifiers 2

IdentifierTypeStateIssuer
2455427MedicaidLA
307246OtherLASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171016001407 LA Practitioner - Physician Assistant 5294001491 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Capitol City Family Health Center Incorporated CurrentSince Jan 27, 2024 Accepting new patients
Capitol City Family Health Center Incorporated Current Accepting new patients
Winn Community Health Center, Inc. CurrentSince Sep 25, 2024 Accepting new patients
Capitol City Family Health Center, Incorporated CurrentSince Jan 27, 2024 Accepting new patients
Winn Community Health Center, Inc. CurrentSince Sep 25, 2024 Accepting new patients

Locations

3140 Florida St
Baton Rouge, LA 70806
Phone (225) 650-2000

2400 Hospital Dr
Ste 370
Bossier City, LA 71111
Phone (318) 746-4460

340 Webb Smith Dr
Colfax, LA 71417
Phone (318) 627-3700

3217 Mabel St
Shreveport, LA 71103

8383 Millicent Way
Ste B
Shreveport, LA 71115
Phone (318) 681-4282

8730 Youree Dr
Shreveport, LA 71115
Phone (318) 405-1505

8730 Youree Dr
Ste A
Shreveport, LA 71115
Phone (318) 221-2707

8730 Youree Dr
Ste Ab
Shreveport, LA 71115
Phone (318) 408-1505

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.

NPI Registry JSON

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

{
    "created_epoch": "1504051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660262400000",
    "number": "1275051229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3217 MABEL ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034022",
            "telephone_number": "318-631-9121",
            "fax_number": "318-631-9126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3217 MABEL ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034022",
            "telephone_number": "318-631-9121",
            "fax_number": "318-631-9126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADLEY",
        "first_name": "DUSTIN",
        "middle_name": "LANE CHAPMAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-30",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2455427",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "307246",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.