NPIMap

Organization Active NPI

Baton Rouge General Medical Center

Doing business as Baton Rouge General Physicians Family Medicine

  • Family Medicine Physician
  • Port Allen, LA
National Provider Identifier
1407284540
Registry record updated Dec 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD019597 Issued in LA
Legal business name
BATON ROUGE GENERAL MEDICAL CENTER
Doing business as
Baton Rouge General Physicians Family Medicine
BRGP Family Medicine-Port Allen
Practice address
610 N Jefferson Ave
Port Allen, LA 70767-2414
Phone
(225) 267-6626
Fax
(225) 267-5993
NPI assigned
Oct 29, 2013
Last updated
Dec 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2018

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

Authorized official

Name
Kendall Johnson
Title
C.F.O.
Phone
(225) 237-1645

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD019597 LA Primary

Addresses

Primary practice location

610 N Jefferson Ave
Port Allen, LA 70767-2414

Mailing address

8490 Picardy Ave
BLDG 200
Baton Rouge, LA 70809-3731
Phone (225) 237-1754

Other names 2

  • BATON ROUGE GENERAL PHYSICIANS FAMILY MEDICINE Doing business as
  • BRGP Family Medicine-Port Allen Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310001522 LA Part B Supplier - Clinic/Group Practice 5193623643 Receives reassigned benefits from 32 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Zachary, LA; Port Allen, LA; Denham Springs, LA; Baton Rouge, LA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2070174Baton Rouge Genral Physicians - Family Medicine610 North Jefferson Avenue, Port Allen, LA 70767Certificate of waiverDec 9, 2027

National Provider Directory

National Provider Directory

Locations

610 N Jefferson Ave
Port Allen, LA 70767
Phone (225) 267-6626

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545782400000",
    "number": "1407284540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8490 PICARDY AVE",
            "address_2": "BLDG 200",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093731",
            "telephone_number": "225-237-1754",
            "fax_number": "225-237-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N JEFFERSON AVE",
            "city": "PORT ALLEN",
            "state": "LA",
            "postal_code": "707672414",
            "telephone_number": "225-267-6626",
            "fax_number": "225-267-5993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BATON ROUGE GENERAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2018-12-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_title_or_position": "C.F.O.",
        "authorized_official_telephone_number": "225-237-1645"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD019597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BATON ROUGE GENERAL PHYSICIANS FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BRGP Family Medicine-Port Allen",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Allen, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.