Michael Alon Angelo, M.D.
Individual provider Active NPI Family Medicine Physician · Bossier City, LA
NPI 1295723955 · NPPES record last updated Apr 17, 2024
Key facts
- NPI
- 1295723955
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 025219 (LA)
- Practice address
- 1000 Chinaberry Dr Ste 800
Bossier City, LA 71111-2455 - Phone
- (318) 392-3372
- Fax
- (318) 392-3373
- NPI assigned
- Oct 7, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 10
Owned or controlled facilities with NPI records 1
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: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Pilgrim Manor Skilled Nursing and Rehabilitation |
Skilled nursing facility | Adp of the SNF | Apr 17, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050812000266 | LA | Practitioner - Family Practice |
9133158827 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 025219 | LA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bossier Family Medicine, LLC | Current |
Accepting new patients | |
| Michael Angelo Apmc | Family Medicine | Current | Accepting new patients |
| Sound Physicians Emergency Medicine of Louisiana Inc | Current |
Accepting new patients | |
| Abaka LLC | Current | Accepting new patients | |
| Cogent Healthcare of Texas, PA | Family Medicine | Current |
Accepting new patients |
| Hospice Care of Louisiana, LLC | Family Medicine | Past | Accepting new patients |
| PMG Opco-Pilgrim LLC | Past | Accepting new patients | |
| Cypress Point Nursing & Rehabilitation Center, LLC | Past | Accepting new patients | |
| 2575 Airline Drive Opco LLC | Past | Accepting new patients |
Locations
4438 Viking Dr
Ste 300
Bossier City, LA 71111
2531 Viking Dr
Bossier City, LA 71111
Phone (318) 681-7000
2351 Viking Dr
Bossier City, LA 71111
Phone (318) 681-4500
2539 Viking Dr
Ste 101
Bossier City, LA 71111
Phone (318) 747-8100
4200 Nelson Rd
Lake Charles, LA 70605
Phone (318) 474-6370
1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138
Interoperability endpoints
- michael.angelo.1@3681.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 025219 | LA | Yes |
Addresses
Primary practice location
1000 Chinaberry Dr Ste 800
Bossier City, LA 71111-2455
Mailing address
4438 Viking Dr Ste 300
Bossier City, LA 71111-7510
Phone (318) 918-0015
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1486434 | Medicaid | LA |
Other providers in Bossier City, LA
- Charlotte Anne Anderson
- Megan Crenshaw Anderson
- Ray'Tasha Anderson
- Andersons Care Services LLC
- Stephanie Anfinson
- Applegate
- Applegate Health Services, Inc.
- Alfonso Aquino
- Marisol Aragon
- Arc of Acadiana, Inc
All providers in Bossier City, LA · Family Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.