NPIMap

Individual provider Active NPI

Anthony K Adeosun, M.D.

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1568570653
Registry record updated Jul 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD202004 Issued in LA
Practice address
333 Doctor Michael Debakey Dr
Suite 120
Lake Charles, LA 70601-5887
Phone
(337) 493-8480
Fax
(337) 493-8482
NPI assigned
Aug 28, 2006
Last updated
Jul 28, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 14928 MS
Family Medicine Physician 207Q00000X MD202004 LA Primary

Addresses

Primary practice location

333 Doctor Michael Debakey Dr
Suite 120
Lake Charles, LA 70601-5887

Mailing address

333 Doctor Michael Debakey Dr
Suite120
Lake Charles, LA 70601-5887
Phone (337) 433-4077

Other identifiers 2

IdentifierTypeStateIssuer
00117499MedicaidMS
1638820MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081015000307 LA Practitioner - Family PracticePractitioner - Pediatric Medicine 1850382516 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Pediatric Medicine
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

333 Doctor Michael Debakey Dr
Suite 120
Lake Charles, LA 70601-5889
Phone (337) 493-8480

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD202004LAMDFamily Medicine Physician
14928MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Haven Family Medicine CurrentSince Aug 20, 2008 Accepting new patients

Locations

333 Doctor Michael Debakey Dr
Ste 120
Lake Charles, LA 70601
Phone (337) 493-8480

333 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 493-8480

Organizations & group practices 2

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438041600000",
    "number": "1568570653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 DOCTOR MICHAEL DEBAKEY DR",
            "address_2": "SUITE120",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015887",
            "telephone_number": "337-433-4077",
            "fax_number": "337-433-5598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 DOCTOR MICHAEL DEBAKEY DR",
            "address_2": "SUITE 120",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015887",
            "telephone_number": "337-493-8480",
            "fax_number": "337-493-8482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEOSUN",
        "first_name": "ANTHONY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2015-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "14928",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD202004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00117499",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1638820",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.