Individual provider Active NPI

Emily K. Leblanc, PA

  • Medical Physician Assistant
  • Bossier City, LA
National Provider Identifier
1457750366
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA.200775 Issued in LA
Practice address
2449 Hospital Dr Ste 300
Bossier City, LA 71111
Phone
(318) 212-7960
Fax
(318) 212-7965
NPI assigned
Aug 15, 2014
Last updated
Jun 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA.200775 LA Primary
Surgical Physician Assistant 363AS0400X PA.200775 LA

Addresses

Primary practice location

2449 Hospital Dr Ste 300
Bossier City, LA 71111

Mailing address

2449 Hospital Dr Ste 300
Bossier City, LA 71111-1910
Phone (318) 212-7960

Other practice location 1

1800 E 70th St
Shreveport, LA 71105-5302
Phone (318) 631-9121

Other practice location 2

8383 Millicent Way
Shreveport, LA 71115
Phone (318) 631-9121

Other practice location 3

8383 Millicent Way
Shreveport, LA 71115
Phone (318) 631-9121

Other identifiers 1

IdentifierTypeStateIssuer
2373072MedicaidLA

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

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
I20141114001188 LA Practitioner - Physician Assistant 4486876042 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
WK Spine and Pain SpecialistsGroup PAC ID 0547569840, 12 clinicians

Practice addresses (Care Compare)

1811 E Bert Kouns Industrial Loop
Suite 300
Shreveport, LA 71105-5751
Phone (318) 212-7960

2449 Hospital Dr
Suite 300
Bossier City, LA 71111-1910
Phone (318) 212-7960

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.200775LAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Capitol City Family Health Center Incorporated Past Accepting new patients
WK River Cities Interventional Pain PastSince Feb 1, 2005 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: eleblanc1@direct.wkhs.com

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": "1408060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625011200000",
    "number": "1457750366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2449 HOSPITAL DR STE 300",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711111910",
            "telephone_number": "318-212-7960",
            "fax_number": "318-212-7965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2449 HOSPITAL DR STE 300",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "71111",
            "telephone_number": "318-212-7960",
            "fax_number": "318-212-7965"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 E 70th St",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055302",
            "country_code": "US",
            "telephone_number": "318-631-9121",
            "fax_number": "318-631-5019",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8383 Millicent Way",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "71115",
            "country_code": "US",
            "telephone_number": "318-631-9121",
            "fax_number": "318-213-6246",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8383 Millicent Way",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "71115",
            "country_code": "US",
            "telephone_number": "318-631-9121",
            "fax_number": "318-213-6246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEBLANC",
        "first_name": "EMILY",
        "middle_name": "K.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-15",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "LA",
            "license": "PA.200775",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "LA",
            "license": "PA.200775",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2373072",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bossier City, LA

Sources for this page

Verify at the official NPI Registry.