Individual provider Active NPI

Alan Lynn Lebato, MD

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1528069739
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
L017157 Issued in LA
Practice address
1525 Oak Park Blvd
Lake Charles, LA 70601-8849
Phone
(337) 494-6767
Fax
(337) 494-6750
NPI assigned
Aug 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X L017157 LA Primary

Addresses

Primary practice location

1525 Oak Park Blvd
Lake Charles, LA 70601-8849

Mailing address

PO Box 123453 Dept 3453
Dallas, TX 75312-0001
Phone (337) 494-2921

Other identifiers 1

IdentifierTypeStateIssuer
1347078MedicaidLA

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110128000689 LA Practitioner - Family Practice 5395749592 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17157LAMDPharmacist
L017157LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lsuhsc Family Practice Center @ LCMH Family Medicine CurrentSince May 1, 1996 Accepting new patients

Locations

1525 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-2023

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1528069739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123453 DEPT 3453",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 OAK PARK BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018849",
            "telephone_number": "337-494-6767",
            "fax_number": "337-494-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBATO",
        "first_name": "ALAN",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "L017157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1347078",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.