Individual provider Active NPI

Charlotte Meyer Sibley, MD

  • Pediatrics Physician
  • Walker, LA
National Provider Identifier
1366021503
Registry record updated Jun 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
342667 Issued in LA
Practice address
5000 Odonavan Blvd Ste 507
Walker, LA 70785-6352
Phone
(225) 271-6584
Fax
(225) 271-6551
NPI assigned
Apr 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2024

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
Pediatrics Physician 208000000X 342667 LA Primary

Addresses

Primary practice location

5000 Odonavan Blvd Ste 507
Walker, LA 70785-6352

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (225) 271-6584

Other practice location 1

8300 Constantin Blvd
Baton Rouge, LA 70809-3489
Phone (225) 374-1316

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
I20240827004429 LA Practitioner - Pediatric Medicine 1052850674 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group, LLC CurrentSince Jul 1, 2024 Accepting new patients
Our Lady of the Lake Physician Group LLC Pediatrics Current Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Jul 1, 2024 Accepting new patients
Our Lady of the Lake Physician Group LLC Past Accepting new patients

Locations

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

8300 Constantin Blvd
Baton Rouge, LA 70809
Phone (225) 374-1410

5000 Odonavan Blvd
Ste 507
Walker, LA 70785
Phone (225) 214-3199

Interoperability endpoints

  • Direct secure messaging: csibley2212758@direct.casso.us.com

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1617580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718928000000",
    "number": "1366021503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "225-271-6584",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 ODONAVAN BLVD STE 507",
            "city": "WALKER",
            "state": "LA",
            "postal_code": "707856352",
            "telephone_number": "225-271-6584",
            "fax_number": "225-271-6551"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8300 Constantin Blvd",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708093489",
            "country_code": "US",
            "telephone_number": "225-374-1316",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIBLEY",
        "first_name": "CHARLOTTE",
        "middle_name": "MEYER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-05",
        "last_updated": "2024-06-21",
        "certification_date": "2024-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "342667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walker, LA

Sources for this page

Verify at the official NPI Registry.