Mandeville Private Physician Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

025708 Issued in LA

Legal business name

MANDEVILLE PRIVATE PHYSICIAN GROUP

Practice address

141 Lakeview Cir
Covington, LA 70433-7513

Phone

(985) 630-9618

Fax

(985) 231-7010

NPI assigned

Oct 16, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Richard Michael Jeansonne Jr., MDNPI 1467468447

Title

Physician

Phone

(985) 630-9618

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Richard Michael Jeansonne Jr., M.D.

  • Family Medicine Physician
  • Mandeville, LA
  • NPI 1467468447
  Medicare reassignment NPD Authorized official
• Robert P Guilbault III, MD

  • Family Medicine Physician
  • Mandeville, LA
  • NPI 1275581092
  NPD (past)

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

{
    "created_epoch": "1413417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1437553617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 335",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704700335",
            "telephone_number": "985-630-9618",
            "fax_number": "985-231-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 LAKEVIEW CIR",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704337513",
            "telephone_number": "985-630-9618",
            "fax_number": "985-231-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDEVILLE PRIVATE PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-16",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "JEANSONNE",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "985-630-9618",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "025708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Ann Mahl, APRN
• Ashlynn Volpe Mahoney, PHARMD
• Faizan Iqbal Malik, MD
• Christel Cary Malinski, MD
• Harvey L Malone, MD
• Joshua Michael Manguno, LCSW
• Kelsey Hershey Manguno, MD
• Mistina Mano Manoharan
• Cyrus Jon Mansouri, DDS
• Laiyatu E. B. Manya, PSYD

• Family Medicine Physician in Covington, LA
• Providers in Covington, LA by specialty
• Family Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.