Matherne Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

MD202680 Issued in LA

Legal business name

MATHERNE DERMATOLOGY, LLC

Practice address

2100 Audubon Ave
Thibodaux, LA 70301-5014

Phone

(985) 446-5888

Fax

(985) 446-5880

NPI assigned

Jul 12, 2013

Organization subpart

No

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

Authorized official

Name

Michele Decker Matherne

Title

Manager

Phone

(504) 975-9577

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ryan Joseph Matherne, MD

  • Dermatology Physician
  • Thibodaux, LA
  • NPI 1528259710
  Medicare reassignment Care Compare group NPD
• Lindsay A Dufresne, PA-C

  • Physician Assistant
  • Thibodaux, LA
  • NPI 1346855715
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1548601016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 AUDUBON AVE",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "70301",
            "telephone_number": "985-446-5888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 AUDUBON AVE",
            "city": "THIBODAUX",
            "state": "LA",
            "postal_code": "703015014",
            "telephone_number": "985-446-5888",
            "fax_number": "985-446-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATHERNE DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-12",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "MATHERNE",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "DECKER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "504-975-9577"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "LA",
            "license": "MD202680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "5DX54",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1500615",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL MEDICARE PTAN",
            "identifier": "4Q145DX54",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ross Martin, BSN, RN
• Savannah Martin, BA
• Vanessa Martinez, FNP. PMHNP
• Mary V. Soignet, LLC
• Stephanie Mashburn
• Brooke Matherne, BSN, RN
• Kim Matherne, RN
• Lori Waguespack Matherne, PT, DPT
• Marjorie Block Matherne, LCSW
• Ryan Joseph Matherne, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; 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.