NPIMap

Individual provider Active NPI

Stanley R Kordisch, M.D.

  • Gynecology Physician
  • Lake Charles, LA
National Provider Identifier
1326008038
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
013813 Issued in LA
Practice address
4150 Nelson Rd
BLDG C-10
Lake Charles, LA 70605-4148
Phone
(337) 474-0653
Fax
(337) 474-0639
NPI assigned
Mar 25, 2006
Last updated
Oct 31, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 013813 LA Primary

Addresses

Primary practice location

4150 Nelson Rd
BLDG C-10
Lake Charles, LA 70605-4148

Mailing address

4150 Nelson Rd
BLDG C-10
Lake Charles, LA 70605-4148
Phone (337) 474-0653

Other identifiers 1

IdentifierTypeStateIssuer
1303160MedicaidLA

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
I20060925000056 LA Practitioner - Obstetrics/Gynecology 2769487867 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Louisiana State University School of Medicine in New Orleans, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ochsner Clinic LLCGroup PAC ID 8224933619, 2,845 clinicians

Practice addresses (Care Compare)

104 Acadia Park Dr
Raceland, LA 70394-2618
Phone (985) 537-3211

4150 Nelson Rd
Suite G
Lake Charles, LA 70605-4133
Phone (337) 562-3761

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
013813LAMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Jan 21, 2019 Accepting new patients
Ochsner Clinic LLC CurrentSince Jan 21, 2019 Accepting new patients
Ochsner Clinic LLC Current Accepting new patients

Locations

9001 Summa Ave
Baton Rouge, LA 70809

4150 Nelson Rd
Ste G
Lake Charles, LA 70605
Phone (337) 310-0440

1514 Jefferson Hwy
New Orleans, LA 70121

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

Interoperability endpoints

  • Direct secure messaging: skordisch691097@direct.ochsner.org

Organizations & group practices 3

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.

Hospital & facility affiliations 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1143244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193788800000",
    "number": "1326008038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 NELSON RD",
            "address_2": "BLDG C-10",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054148",
            "telephone_number": "337-474-0653",
            "fax_number": "337-474-0639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 NELSON RD",
            "address_2": "BLDG C-10",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054148",
            "telephone_number": "337-474-0653",
            "fax_number": "337-474-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDISCH",
        "first_name": "STANLEY",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-25",
        "last_updated": "2007-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "LA",
            "license": "013813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1303160",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.