Integrated Dermatology of Ponchatoula, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTEGRATED DERMATOLOGY OF PONCHATOULA, LLC

Practice address

180 N 5TH St
Ponchatoula, LA 70454-2532

Phone

(985) 370-7546

NPI assigned

Sep 4, 2015

Last updated

May 21, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey Queen

Title

Manager

Phone

(561) 314-2000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 14

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.

• Robert W Benson, M.D.

  • Dermatology Physician
  • Ponchatoula, LA
  • NPI 1962406843
  Medicare reassignment Care Compare group NPD
• Kimberly Paternostro Bordelon

  • Family Nurse Practitioner
  • Ponchatoula, LA
  • NPI 1013368794
  Medicare reassignment Care Compare group NPD
• Falon Victoria Brown, D.O.

  • Dermatology Physician
  • Ponchatoula, LA
  • NPI 1932542198
  Medicare reassignment Care Compare group NPD
• Nicholas Frank, MD

  • MOHS-Micrographic Surgery Physician
  • Baton Rouge, LA
  • NPI 1396163721

  Dermatology

  Medicare reassignment Care Compare group NPD
• Susan Barringer Smith, APRN, FNP-C, PNP-C

  • Nurse Practitioner
  • Ponchatoula, LA
  • NPI 1154441251
  Medicare reassignment Care Compare group NPD
• Joseph Willis, M.D.

  • Student in an Organized Health Care Education/Training Program
  • Metairie, LA
  • NPI 1407113079

  Dermatology

  Medicare reassignment Care Compare group NPD
• Caitlin Craddock Field, PA-C

  • Physician Assistant
  • Baton Rouge, LA
  • NPI 1417408279
  Medicare reassignment Care Compare group
• Ashley Hotard, PA-C

  • Physician Assistant
  • Hammond, LA
  • NPI 1245752120
  Medicare reassignment Care Compare group
• Kamryn Alise King, PA-C

  • Physician Assistant
  • Walker, LA
  • NPI 1528899218
  Medicare reassignment Care Compare group
• Elizabeth F Bucher, M.D.

  • MOHS-Micrographic Surgery Physician
  • Metairie, LA
  • NPI 1295995546

  Dermatology

  Medicare reassignment NPD
• Emily Navarro Campbell

  • Physician Assistant
  • Gretna, LA
  • NPI 1306578315
  Medicare reassignment NPD
• Keith Gerard Leblanc Jr., M.D.

  • MOHS-Micrographic Surgery Physician
  • Metairie, LA
  • NPI 1972765493

  Dermatology

  Medicare reassignment NPD

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

{
    "created_epoch": "1441324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558396800000",
    "number": "1508234600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-314-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 N 5TH ST",
            "city": "PONCHATOULA",
            "state": "LA",
            "postal_code": "704542532",
            "telephone_number": "985-370-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED DERMATOLOGY OF PONCHATOULA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-04",
        "last_updated": "2019-05-21",
        "status": "A",
        "authorized_official_last_name": "QUEEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "561-314-2000"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Home Testing Management
• Hospital Service District #1 of Tangipahoa Parish (North Oaks Medical Center Home Health Agency)
• Lisa Ann Howes, P.T.
• Brooke Hughes-Daniels
• Christy Beth Hutchinson, PMHNP-BC
• J. Allen Investment LLC (Alpha Garden Agency)
• J. Allen Investments LLC.
• Lakelia Jackson
• Bridgette Jarred
• Alvin Julian Jaufre III, D.C.

• Dermatology Physician in Ponchatoula, LA
• Providers in Ponchatoula, LA by specialty
• Dermatology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.