Organization Active NPI

Lakeview Regional Physician Group LLC

  • Pediatrics Physician
  • Covington, LA
National Provider Identifier
1285890467
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
LAKEVIEW REGIONAL PHYSICIAN GROUP LLC
Practice address
130 Lakeview Circle
Covington, LA 70433-0001
Phone
(985) 892-6858
Fax
(866) 457-6080
NPI assigned
Aug 6, 2008
Last updated
Jun 9, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Authorized official

Name
Mr. John Rebok
Title
Group Vice President/Ao
Phone
(615) 377-5004

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

130 Lakeview Circle
Covington, LA 70433-0001

Mailing address

PO Box 405453
Atlanta, GA 30384-5453
Phone (615) 373-7600

Other identifiers 2

IdentifierTypeStateIssuer
00837785MedicaidMS
1384313MedicaidLA

National Provider Directory

National Provider Directory

Locations

101 Judge Tanner Blvd
Ste 206A
Covington, LA 70433
Phone (985) 845-0004

71192 Highway 21
#100
Covington, LA 70433
Phone (985) 871-6020

73015 Highway 25
Ste A
Covington, LA 70435
Phone (985) 246-2420

2581 Florida St
Ste C
Mandeville, LA 70448
Phone (504) 644-4226

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1285890467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 405453",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303845453",
            "telephone_number": "615-373-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 LAKEVIEW CIRCLE",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704330001",
            "telephone_number": "985-892-6858",
            "fax_number": "866-457-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVIEW REGIONAL PHYSICIAN GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-06",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "REBOK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "GROUP VICE PRESIDENT/AO",
        "authorized_official_telephone_number": "615-377-5004",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00837785",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1384313",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.