Individual provider Active NPI

Terry Gay Sanders, PA-C

  • Medical Physician Assistant
  • Baton Rouge, LA
National Provider Identifier
1457373664
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
A10174 Issued in LA
Practice address
5247 Didesse Dr
Baton Rouge, LA 70808-9153
Phone
(225) 765-3076
Fax
(225) 765-3090
NPI assigned
Jul 24, 2006
Last updated
Feb 10, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X A10174 LA Primary

Addresses

Primary practice location

5247 Didesse Dr
Baton Rouge, LA 70808-9153

Mailing address

8300 Jo Lee Dr
Denham Springs, LA 70706-8539
Phone (225) 937-4086

Other identifiers 2

IdentifierTypeStateIssuer
1009733MedicaidLA
P00408733OtherLARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070518000023 LA Practitioner - Physician Assistant 7012014558 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A10174LAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC CurrentSince Jul 1, 2012 Accepting new patients
Our Lady of the Lake Physician Group, LLC CurrentSince Jul 1, 2012 Accepting new patients
Our Lady of the Lake Hospital Inc Past Accepting new patients

Locations

5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone (225) 765-4050

5247 Didesse Dr
Baton Rouge, LA 70808
Phone (225) 765-2273

8415 Goodwood Blvd
Ste 105
Baton Rouge, LA 70806
Phone (225) 765-4226

18989 Old Scenic Hwy
Zachary, LA 70791
Phone (225) 654-6140

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581292800000",
    "number": "1457373664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 JO LEE DR",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707068539",
            "telephone_number": "225-937-4086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5247 DIDESSE DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089153",
            "telephone_number": "225-765-3076",
            "fax_number": "225-765-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "TERRY",
        "middle_name": "GAY",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-24",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "A10174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009733",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00408733",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.