NPIMap

Organization Active NPI

Our Lady of the Lake Physician Group LLC

  • Family Medicine Physician
  • New Roads, LA
National Provider Identifier
1518006568
Registry record updated Dec 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
Practice address
160 Hospital Rd
New Roads, LA 70760-2617
Phone
(225) 638-4686
Fax
(225) 638-4203
NPI assigned
Feb 6, 2007
Organization subpart
Yes
Parent organization
OUR LADY OF THE LAKE HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2012

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

Authorized official

Name
Elona Sharbaugh
Title
VP Physician Practices
Phone
(225) 490-8806

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

160 Hospital Rd
New Roads, LA 70760-2617

Mailing address

2051 Silverside Dr
Suite 120
Baton Rouge, LA 70808-9005
Phone (225) 765-4226

Other identifiers 1

IdentifierTypeStateIssuer
1447536MedicaidLA

National Provider Directory

National Provider Directory
Tax ID family
Our Lady of the Lake Physician Group LLC5 organizations share this tax ID, including this one
Part of
Industrial Family Medic

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355097600000",
    "number": "1518006568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2051 SILVERSIDE DR",
            "address_2": "SUITE 120",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089005",
            "telephone_number": "225-765-4226",
            "fax_number": "225-765-9244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 HOSPITAL RD",
            "city": "NEW ROADS",
            "state": "LA",
            "postal_code": "707602617",
            "telephone_number": "225-638-4686",
            "fax_number": "225-638-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF THE LAKE PHYSICIAN GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OUR LADY OF THE LAKE HOSPITAL INC",
        "enumeration_date": "2007-02-06",
        "last_updated": "2012-12-10",
        "status": "A",
        "authorized_official_last_name": "SHARBAUGH",
        "authorized_official_first_name": "ELONA",
        "authorized_official_title_or_position": "VP PHYSICIAN PRACTICES",
        "authorized_official_telephone_number": "225-490-8806"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447536",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Roads, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.