NPIMap

Individual provider Active NPI

Nathan J Ambrose, PA

  • Surgical Physician Assistant
  • Lafayette, LA
National Provider Identifier
1326694076
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
324792 Issued in LA
Practice address
5000 Ambassador Caffery Pkwy Ste a
Lafayette, LA 70508-6984
Phone
(337) 470-3580
Fax
(337) 470-3586
NPI assigned
Aug 16, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Physician Assistant 363AS0400X 324792 LA Primary

Addresses

Primary practice location

5000 Ambassador Caffery Pkwy Ste a
Lafayette, LA 70508-6984

Mailing address

1132 Gather Dr
Lawrenceville, GA 30043-7549
Phone (810) 625-4218

Other practice location 1

625 Old Peachtree Rd NW
Suwanee, GA 30024-2937
Phone (810) 625-4218

Other identifiers 2

IdentifierTypeStateIssuer
058924-PAOtherLACDS
324792OtherLASTATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20201113000393 LA Practitioner - Physician Assistant 3072923408 Reassigns benefits to 1 organization
I20230814003866 CO Practitioner - Physician Assistant 3072923408 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lourdes Physician Group LLCGroup PAC ID 7214177757, 157 clinicians

Practice addresses (Care Compare)

1050 Wellington Ave
Imh Wellington Lung and Sleep Clinic
Grand Junction, CO 81501-8121
Phone (970) 298-5864

2635 N 7TH St
Grand Junction, CO 81501-8209

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917
Phone (337) 470-2990

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Aug 1, 2023 Accepting new patients
Intermountain Medical Group Grand Junction, LLC CurrentSince Aug 1, 2023 Accepting new patients
St Mary's Hospital and Medical Center, Inc Past Accepting new patients
Paeon Health Services Inc Past Accepting new patients

Locations

500 Eldorado Blvd
Ste 4300
Broomfield, CO 80021

1050 Wellington Ave
Grand Junction, CO 81501
Phone (970) 245-4810

2643 Patterson Rd
Ste 403
Grand Junction, CO 81506
Phone (970) 298-7662

1050 Wellington Ave
Slp Ctr
Grand Junction, CO 81501
Phone (970) 298-5864

Organizations & group practices 6

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 5

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": "1565913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1326694076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 GATHER DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300437549",
            "telephone_number": "810-625-4218"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 AMBASSADOR CAFFERY PKWY STE A",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086984",
            "telephone_number": "337-470-3580",
            "fax_number": "337-470-3586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "625 Old Peachtree Rd NW",
            "address_purpose": "LOCATION",
            "city": "Suwanee",
            "state": "GA",
            "postal_code": "300242937",
            "country_code": "US",
            "telephone_number": "810-625-4218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AMBROSE",
        "first_name": "NATHAN",
        "middle_name": "J",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-16",
        "last_updated": "2023-03-07",
        "certification_date": "2020-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "324792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDS",
            "identifier": "058924-PA",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "324792",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.