NPIMap

Individual provider Active NPI

Michael Alon Angelo, M.D.

  • Family Medicine Physician
  • Bossier City, LA
National Provider Identifier
1295723955
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
025219 Issued in 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
Last updated
Apr 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 025219 LA Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20050812000266 LA Practitioner - Family PracticePractitioner - Internal Medicine 9133158827 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
025219LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Abaka LLC Current Accepting new patients
Sound Physicians Emergency Medicine of Louisiana Inc CurrentSince Jul 1, 2019 Accepting new patients
Michael Angelo Apmc Family Medicine Current Accepting new patients
Bossier Family Medicine, LLC CurrentSince Sep 11, 2022 Accepting new patients
Cogent Healthcare of Texas, PA Family Medicine CurrentSince Oct 15, 2022 Accepting new patients
Hospice Care of Louisiana, LLC Family Medicine Past Accepting new patients
PMG Opco-Pilgrim LLC Past Accepting new patients
2575 Airline Drive Opco LLC Past Accepting new patients
Cypress Point Nursing & Rehabilitation Center, LLC Past Accepting new patients

Locations

2351 Viking Dr
Bossier City, LA 71111
Phone (318) 681-4500

2531 Viking Dr
Bossier City, LA 71111
Phone (318) 681-7000

2539 Viking Dr
Ste 101
Bossier City, LA 71111
Phone (318) 747-8100

4438 Viking Dr
Ste 300
Bossier City, LA 71111

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

  • Direct secure messaging: michael.angelo.1@3681.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Pilgrim Manor Skilled Nursing and RehabilitationBossier City, LA, CCN 195594 Skilled nursing facility Adp of the SNF Apr 17, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 10

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": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713312000000",
    "number": "1295723955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4438 VIKING DR STE 300",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711117510",
            "telephone_number": "318-918-0015",
            "fax_number": "318-963-0015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 CHINABERRY DR STE 800",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112455",
            "telephone_number": "318-392-3372",
            "fax_number": "318-392-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANGELO",
        "first_name": "MICHAEL",
        "middle_name": "ALON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "025219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.