NPIMap

Individual provider Active NPI

Edmund Gerard Lacour, M.D.

  • Rheumatology Physician
  • Dothan, AL
National Provider Identifier
1285689463
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
00016999 Issued in AL
Practice address
1118 Ross Clark Cir
Suite 100
Dothan, AL 36301-3001
Phone
(334) 794-1148
Fax
(334) 793-1954
NPI assigned
May 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 00016999 AL Primary

Addresses

Primary practice location

1118 Ross Clark Cir
Suite 100
Dothan, AL 36301-3001

Mailing address

1118 Ross Clark Cir
Suite 100
Dothan, AL 36301-3001
Phone (334) 794-1148

Other identifiers 3

IdentifierTypeStateIssuer
051516047OtherALBCBS
51553686MedicaidAL
0017489OtherALTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20100602000572 AL Practitioner - Rheumatology 9234218108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Tulane University School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dothan Medical Associates, P.C.Group PAC ID 7416848247, 17 clinicians

Practice addresses (Care Compare)

1118 Ross Clark Cir
Suite 100
Dothan, AL 36301-3023
Phone (334) 794-1148

Hospital & facility affiliations

  • Southeast Health Medical Center Hospital, Dothan, AL, CCN 010001
  • Dale Medical Center Hospital, Ozark, AL, CCN 010021
  • Mizell Memorial Hospital Hospital, Opp, AL, CCN 010007
  • Jackson Hospital Hospital, Marianna, FL, CCN 100142
  • Doctors Memorial Hospital Hospital, Bonifay, FL, CCN 101307

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00016999ALMDRheumatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dothan Medical Associates, P.C. CurrentSince Jul 11, 1995 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

1118 Ross Clark Cir
Ste 100
Dothan, AL 36301
Phone (334) 794-1148

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.441.37

Organizations & group practices 2

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

Hospital & facility affiliations 5

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": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327363200000",
    "number": "1285689463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIR",
            "address_2": "SUITE 100",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013001",
            "telephone_number": "334-794-1148",
            "fax_number": "334-793-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIR",
            "address_2": "SUITE 100",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013001",
            "telephone_number": "334-794-1148",
            "fax_number": "334-793-1954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACOUR",
        "first_name": "EDMUND",
        "middle_name": "GERARD",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2012-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "AL",
            "license": "00016999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "051516047",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "51553686",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "0017489",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

Verify at the official NPI Registry.