Michael Berthiaume, PA

Key facts

NPI

1285731455

Entity type

Individual (NPI type 1)

Primary specialty

Medical Physician Assistant 363AM0700X

License

A10615 (LA)

Practice address

1990 Industrial Boulevard
Houma, LA 70363-7055

Phone

(985) 868-9300

Fax

(985) 851-0053

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 3

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.

• Children'S Hospital Specialist · New Orleans, LA · NPI 1043230873
  Medicare reassignment NPD LA
• South Louisiana Medical Associates Surgery Physician · Houma, LA · NPI 1942301379
  Medicare reassignment NPD LA · MEDICAL
• South Louisiana Medical Associates Durable Medical Equipment & Medical Supplies · Morgan City, LA · NPI 1972047108
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 17, 2009.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245196800000",
    "number": "1285731455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 INDUSTRIAL BOULEVARD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637055",
            "telephone_number": "985-868-9300",
            "fax_number": "985-851-0053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 INDUSTRIAL BOULEVARD",
            "city": "HOUMA",
            "state": "LA",
            "postal_code": "703637055",
            "telephone_number": "985-868-9300",
            "fax_number": "985-851-0053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTHIAUME",
        "first_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2009-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "A10615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1626791",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houma, LA

• Ted Patrick Bergeron
• Tori Nicole Bergeron
• Carolyn W Bernard, MSW, CSW
• Larry David Bernard, D.C.
• Amber Lynn Berry, APRN
• Wednesday Berthiaume, OT
• Gerard Anthony Bertolino, M.D.
• Best Practice Associates, Inc.
• Allison Jernea Betts, MSW
• Matthew Beyer

All providers in Houma, LA · Medical Physician Assistant in Louisiana