Our Lady of the Lake Physician Group LLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

OUR LADY OF THE LAKE PHYSICIAN GROUP LLC

Doing business as

Lake Physician Group Cardiology Ser

Practice address

8415 Goodwood Blvd
Ste 105
Baton Rouge, LA 70806-7851

Phone

(225) 765-5727

Fax

(225) 765-4278

NPI assigned

Nov 24, 2010

Last updated

Nov 24, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

OUR LADY OF THE LAKE PHYSICIAN GROUP LLCAs reported in NPPES

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

Authorized official

Name

Elona Sharbaugh

Title

VP Physician Practices

Phone

(225) 765-8680

Specialties & licenses 1

Addresses

Other names 1

• Lake Physician Group Cardiology Ser Doing business as

Part of

Olol Physician Group LLC

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Our Lady of the Lake Hospital Inc.

  dba Our Lady of the Lake Regional Medical Center

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123

  Member Of

  NPD member
• Franciscan Missionaries of Our Lady Health System Inc

  dba RxONE St Dominic

  • Pharmacy
  • Jackson, MS
  • NPI 1932892601

  Member Of

  NPD member

Locations

Practitioners 1

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.

• Jeffrey Keith Moonan, M.D.

  • Cardiovascular Disease Physician
  • Baton Rouge, LA
  • NPI 1174515670
  NPD (past)

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

{
    "created_epoch": "1290556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290556800000",
    "number": "1356643399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 GOODWOOD BLVD",
            "address_2": "STE 105",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067851",
            "telephone_number": "225-765-5727",
            "fax_number": "225-765-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8415 GOODWOOD BLVD",
            "address_2": "STE 105",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067851",
            "telephone_number": "225-765-5727",
            "fax_number": "225-765-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF THE LAKE PHYSICIAN GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUR LADY OF THE LAKE PHYSICIAN GROUP LLC",
        "enumeration_date": "2010-11-24",
        "last_updated": "2010-11-24",
        "status": "A",
        "authorized_official_last_name": "SHARBAUGH",
        "authorized_official_first_name": "ELONA",
        "authorized_official_title_or_position": "VP PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "225-765-8680"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Physician Group Cardiology Ser",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Our Lady of the Lake Physician Group, LLC
• Our Lady of the Lake Physician Group, LLC
• Our Lady of the Lake Plastic Clinic (Our Lady of the Lake Regional Medical Center)
• Our Lady of the Lake Regional Medica (Our Lady Of The Lake Hospital Inc Pediatric Pulmonary Clinic)

• Cardiovascular Disease Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Cardiovascular Disease Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.