NPIMap

Organization Active NPI

Northlake Anesthesiologists, a Professional Corporation

  • Anesthesiology Physician
  • Slidell, LA
National Provider Identifier
1306949185
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
NORTHLAKE ANESTHESIOLOGISTS, A PROFESSIONAL CORPORATION
Practice address
636 Gause Blvd Ste 300
Slidell, LA 70458-2007
Phone
(985) 649-4063
Fax
(985) 649-2833
NPI assigned
Sep 6, 2006
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Dr. Anthony Joseph Scurria, MDNPI 1962579573
Title
Vice President
Phone
(504) 717-5387

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

636 Gause Blvd Ste 300
Slidell, LA 70458-2007

Mailing address

636 Gause Blvd
Suite 300
Slidell, LA 70458-2007
Phone (985) 649-4063

Other practice location 1

1700 Lindberg Dr
Slidell, LA 70458-8062
Phone (985) 641-0600

Other identifiers 2

IdentifierTypeStateIssuer
1796450MedicaidLA
26676OtherLABLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040614000209 LA Part B Supplier - Clinic/Group Practice 3072597681 Receives reassigned benefits from 63 practitioners
Practice locations: Slidell, LA

National Provider Directory

National Provider Directory

Locations

636 Gause Blvd
Ste 200
Slidell, LA 70458
Phone (985) 641-8008

636 Gause Blvd
Ste 300
Slidell, LA 70458
Phone (985) 641-8008

Practitioners & affiliated clinicians

Practitioners 81

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.

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1306949185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 GAUSE BLVD",
            "address_2": "SUITE 300",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582007",
            "telephone_number": "985-649-4063",
            "fax_number": "985-649-2833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 GAUSE BLVD STE 300",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582007",
            "telephone_number": "985-649-4063",
            "fax_number": "985-649-2833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 Lindberg Dr",
            "address_purpose": "LOCATION",
            "city": "Slidell",
            "state": "LA",
            "postal_code": "704588062",
            "country_code": "US",
            "telephone_number": "985-641-0600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHLAKE ANESTHESIOLOGISTS, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "SCURRIA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "504-717-5387",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1796450",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "26676",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.