Individual provider Active NPI

Shawn Hall, M.D.

  • Family Medicine Physician
  • Gonzales, LA
National Provider Identifier
1306844147
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
10010R Issued in LA
Practice address
2647 S Saint Elizabeth Blvd Ste 100
Gonzales, LA 70737-5019
Phone
(225) 765-5500
Fax
(225) 644-5415
NPI assigned
Jul 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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 10010R LA Primary

Addresses

Primary practice location

2647 S Saint Elizabeth Blvd Ste 100
Gonzales, LA 70737-5019

Mailing address

2647 S Saint Elizabeth Blvd Ste 100
Gonzales, LA 70737-5019
Phone (225) 765-5500

Other identifiers 1

IdentifierTypeStateIssuer
1970816MedicaidLA

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address shall3401@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040427001284 LA Practitioner - Family Practice 3971590472 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Texas Southwestern Medical School at Dallas, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

2647 S Saint Elizabeth Blvd
Suite 100
Gonzales, LA 70737-5019
Phone (225) 647-8511

Hospital & facility affiliations

  • Feliciana Home Health South Home health agency, Gonzales, LA, CCN 197102
  • Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064
  • Womans Hospital Hospital, Baton Rouge, LA, CCN 190128

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10010RLAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC Family Medicine Current Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Mar 1, 2019 Accepting new patients
Our Lady of the Lake Physician Group, LLC CurrentSince Mar 1, 2019 Accepting new patients
Our Lady of the Lake Physician Group LLC Past Accepting new patients
Ascension Surgical Associates, LLC Past Accepting new patients

Locations

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

2647 S Saint Elizabeth Blvd
Ste 100
Gonzales, LA 70737
Phone (225) 743-2707

2647 S Saint Elizabeth Blvd
Ste 125
Gonzales, LA 70737
Phone (225) 647-9675

1702 N Burnside Ave
#B
Gonzales, LA 70737
Phone (225) 647-8319

Organizations & group practices 5

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 3

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": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1306844147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2647 S SAINT ELIZABETH BLVD STE 100",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375019",
            "telephone_number": "225-765-5500",
            "fax_number": "225-644-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2647 S SAINT ELIZABETH BLVD STE 100",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375019",
            "telephone_number": "225-765-5500",
            "fax_number": "225-644-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "SHAWN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-13",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "10010R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1970816",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "shall3401@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "shall3401@direct.casso.us.com",
            "address_1": "2647 S Saint Elizabeth Blvd Ste 100",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2647 S Saint Elizabeth Blvd Ste 100",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gonzales, LA

Sources for this page

Verify at the official NPI Registry.