NPIMap

Individual provider Active NPI

Tyler Jordan Zachary, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • Lake Charles, LA
National Provider Identifier
1386025336
Registry record updated Mar 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
324348 Issued in LA
Practice address
1727 Imperial Blvd BLDG 2
Lake Charles, LA 70605-5393
Phone
(337) 310-3670
Fax
(337) 421-1408
NPI assigned
Jun 16, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 324348 LA Primary

Addresses

Primary practice location

1727 Imperial Blvd BLDG 2
Lake Charles, LA 70605-5393

Mailing address

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (433) 337-8400

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
I20201103000182 LA Practitioner - EndocrinologyPractitioner - Internal Medicine 5193031276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imperial Health LLPGroup PAC ID 7719886779, 75 clinicians

Practice addresses (Care Compare)

1322 Elton Rd
Suite H
Jennings, LA 70546-4100
Phone (337) 246-7200

277N Hwy 171
Suite 8
Lake Charles, LA 70611-5374
Phone (337) 312-0030

4201 Nelson Rd
Suite 100
Lake Charles, LA 70605-4117
Phone (337) 310-2273

501 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 433-8400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health LLP CurrentSince Sep 10, 2020 Accepting new patients
Imperial Health, LLP Internal Medicine CurrentSince Sep 10, 2020 Accepting new patients

Locations

1727 Imperial Blvd
Bldg 2
Lake Charles, LA 70605
Phone (337) 310-3670

1920 W Sale Rd
Ste F2
Lake Charles, LA 70605

1920 W Sale Rd
Ste 2
Lake Charles, LA 70605
Phone (337) 312-8284

501 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8258

Interoperability endpoints

  • Direct secure messaging: tyler.zachary@1288.direct.myezyaccess.com

Organizations & group practices 2

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": "1434412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616371200000",
    "number": "1386025336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "433-337-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1727 IMPERIAL BLVD BLDG 2",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055393",
            "telephone_number": "337-310-3670",
            "fax_number": "337-421-1408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZACHARY",
        "first_name": "TYLER",
        "middle_name": "JORDAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-16",
        "last_updated": "2021-03-22",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "LA",
            "license": "324348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.