Individual provider Active NPI

Richard J. Grisoli, M.D.

  • Anesthesiology Physician
  • Hammond, LA
National Provider Identifier
1568467413
Registry record updated Apr 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
016201 Issued in LA
Practice address
15790 Paul Vega MD Dr
Hammond, LA 70403-1434
Phone
(985) 345-8867
Fax
(985) 542-5322
NPI assigned
Jun 16, 2005
Last updated
Apr 24, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 016201 LA Primary
Critical Care Medicine (Anesthesiology) Physician 207LC0200X 016201 LA
Phlebology Physician 202K00000X ME92186 FL

Addresses

Primary practice location

15790 Paul Vega MD Dr
Hammond, LA 70403-1434

Mailing address

93 Bogue Falaya Dr
Covington, LA 70433-4303
Phone (985) 230-6688

Other identifiers 1

IdentifierTypeStateIssuer
1337781MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, FL3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20071005000278 LA Practitioner - Anesthesiology 3274627773 Reassigns benefits to 1 organization
I20080619000265 FL Practitioner - Anesthesiology 3274627773
I20230825002328 LA Practitioner - Critical Care (Intensivists) 3274627773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

220 Dalwill Dr
Suite 102
Mandeville, LA 70471-3482
Phone (985) 507-9116

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal61

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
16201LAMDPharmacist
016201LAMDCritical Care Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northshore Laser & Vein Center LLC CurrentSince Aug 10, 2023 Accepting new patients
Cardiovascular and Thoracic Surgeons of the South, LLC CurrentSince Aug 1, 2019 Accepting new patients
Laurence Michael May, MD, Apmc Anesthesiology Past Accepting new patients
Vein Clinics of Hawaii LLC Past Accepting new patients
North Oaks Anesthesiology Associates LLC Anesthesiology PastSince Aug 15, 2007 Accepting new patients

Locations

220 Dalwill Dr
Ste 102
Mandeville, LA 70471
Phone (985) 507-9116

4080 Lonesome Rd
Ste A
Mandeville, LA 70448
Phone (985) 892-2950

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492992000000",
    "number": "1568467413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 BOGUE FALAYA DR",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704334303",
            "telephone_number": "985-230-6688",
            "fax_number": "985-230-6176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15790 PAUL VEGA MD DR",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704031434",
            "telephone_number": "985-345-8867",
            "fax_number": "985-542-5322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISOLI",
        "first_name": "RICHARD",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2017-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "LA",
            "license": "016201",
            "primary": true
        },
        {
            "code": "207LC0200X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Critical Care Medicine",
            "state": "LA",
            "license": "016201",
            "primary": false
        },
        {
            "code": "202K00000X",
            "taxonomy_group": "",
            "desc": "Phlebology",
            "state": "FL",
            "license": "ME92186",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1337781",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, LA

Sources for this page

Verify at the official NPI Registry.