NPIMap

Organization Active NPI

Lake Professionals LLC

  • General Practice Physician
  • Lafayette, LA
National Provider Identifier
1497313670
Registry record updated Apr 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
LAKE PROFESSIONALS LLC
Practice address
501 W Saint Mary Blvd Ste 210
Lafayette, LA 70506-4699
Phone
(337) 233-1114
NPI assigned
Jun 3, 2019
Last updated
Apr 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2023

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

Authorized official

Name
Mr. Douglass H Perret
Title
Ceo
Phone
(337) 233-1114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

501 W Saint Mary Blvd Ste 210
Lafayette, LA 70506-4699

Mailing address

PO Box 53388
Lafayette, LA 70505-3388
Phone (337) 233-1114

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230518000653 LA Part B Supplier - Clinic/Group Practice 8224494166 Receives reassigned benefits from 6 practitioners
Practice locations: Lafayette, LA; Pineville, LA

National Provider Directory

National Provider Directory

Locations

501 W Saint Mary Blvd
Ste 210
Lafayette, LA 70506
Phone (337) 233-1114

5505 Shreveport Hwy
Pineville, LA 71360
Phone (318) 441-5900

Practitioners & affiliated clinicians

Practitioners 10

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": "1559520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682380800000",
    "number": "1497313670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53388",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705053388",
            "telephone_number": "337-233-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W SAINT MARY BLVD STE 210",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705064699",
            "telephone_number": "337-233-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE PROFESSIONALS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-03",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A",
        "authorized_official_last_name": "PERRET",
        "authorized_official_first_name": "DOUGLASS",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "337-233-1114",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; 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.