NPIMap

Individual provider Active NPI

Timothy Takach

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1386105740
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
331233 Issued in LA
Practice address
1525 Oak Park Blvd
Lake Charles, LA 70601-8849
Phone
(337) 494-6767
Fax
(337) 494-6750
NPI assigned
Mar 28, 2019
Last updated
Aug 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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 309446 LA
Family Medicine Physician 207Q00000X 331233 LA Primary

Addresses

Primary practice location

1525 Oak Park Blvd
Lake Charles, LA 70601-8849

Mailing address

PO Box 123453 Dept 3453
Dallas, TX 75312-3453
Phone (337) 494-2772

Other identifiers 1

IdentifierTypeStateIssuer
2496328MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ttakach@lcmh.com Direct

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
I20220913001175 LA Practitioner - Family Practice 7012240542 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Texas HSC, College of Osteopathic Med, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lsuhsc Family Practice Center @ LCMHGroup PAC ID 0042297558, 8 clinicians

Practice addresses (Care Compare)

1525 Oak Park Blvd
Lake Charles, LA 70601-8849
Phone (337) 494-6767

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
309446LAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Lsuhsc Family Practice Center @ LCMH Family Medicine CurrentSince Jul 18, 2022 Accepting new patients

Locations

1525 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-2023

Interoperability endpoints

  • Direct secure messaging: ttakach5281942@direct.casso.us.com

Organizations & group practices 1

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 11

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": "1553731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1386105740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123453 DEPT 3453",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753123453",
            "telephone_number": "337-494-2772",
            "fax_number": "337-494-2928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 OAK PARK BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018849",
            "telephone_number": "337-494-6767",
            "fax_number": "337-494-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKACH",
        "first_name": "TIMOTHY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-28",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "LA",
            "license": "309446",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "331233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2496328",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ttakach@lcmh.com",
            "affiliation": "N",
            "endpointDescription": "LSU Residency Program",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1525 Oak Park Blvd",
            "city": "Lake Charles",
            "state": "LA",
            "country_code": "US",
            "postal_code": "706018849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.