NPIMap

Individual provider Active NPI

Gerard M. Victoriano Jr., PA

  • Physician Assistant
  • Lake Charles, LA
National Provider Identifier
1447585583
Registry record updated Oct 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.200317 Issued in LA
Practice address
524 Dr Michael Debakey Dr
Lake Charles, LA 70601-5725
Phone
(337) 491-7709
Fax
(337) 491-7157
NPI assigned
Oct 7, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.200317 LA Primary

Addresses

Primary practice location

524 Dr Michael Debakey Dr
Lake Charles, LA 70601-5725

Mailing address

14050 NW 14TH St
Suite 190
Sunrise, FL 33323-2865
Phone (800) 424-3672

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
I20091124000262 LA Practitioner - Physician Assistant 2860531241 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neurosurgery Consultants, LLCGroup PAC ID 4789062837, 2 clinicians

Practice addresses (Care Compare)

4150 Nelson Rd
BLDG C10
Lake Charles, LA 70605-4169
Phone (337) 240-7280

Hospital & facility affiliations

  • Christus Ochsner Lake Area Hospital Hospital, Lake Charles, LA, CCN 190201
  • West Calcasieu Cameron Hospital Hospital, Sulphur, LA, CCN 190013
  • Christus Ochsner St Patrick Hospital Hospital, Lake Charles, LA, CCN 190027
  • Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060
  • Beauregard Memorial Hospital Hospital, Deridder, LA, CCN 190050

Merit-based Incentive Payment System (MIPS)

Final score
90.84 of 100Reported as group
Quality
82.42
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.200317LAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Charles Primary Care and Wellness Past Accepting new patients
Grosbeak Emergency Physicians LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: gvictoriano415897@christushealth.direct-ci.net

Organizations & group practices 7

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.

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": "1254873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254873600000",
    "number": "1447585583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14050 NW 14TH ST",
            "address_2": "SUITE 190",
            "city": "SUNRISE",
            "state": "FL",
            "postal_code": "333232865",
            "telephone_number": "800-424-3672",
            "fax_number": "954-377-3042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015725",
            "telephone_number": "337-491-7709",
            "fax_number": "337-491-7157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTORIANO",
        "first_name": "GERARD",
        "middle_name": "M.",
        "name_suffix": "Jr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-07",
        "last_updated": "2009-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA.200317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.