NPIMap

Individual provider Active NPI

John H Upshaw Jr., MD

  • Urology Physician
  • Lake Charles, LA
National Provider Identifier
1598770869
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD.023910.R Issued in LA
Practice address
2770 3Rd Ave Ste 240
Lake Charles, LA 70601-8994
Phone
(337) 494-4656
Fax
(337) 494-4657
NPI assigned
Jul 29, 2006
Last updated
Apr 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD.023910.R LA Primary

Addresses

Primary practice location

2770 3Rd Ave Ste 240
Lake Charles, LA 70601-8994

Mailing address

PO Box 122525 Dept 2525
Dallas, TX 75312-0001
Phone (337) 494-2921

Other identifiers 2

IdentifierTypeStateIssuer
1577731MedicaidLA
MD.023910.ROtherLASTATE MEDICAL LICENSE

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
I20070316000211 LA Practitioner - Urology 9931202652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Louisiana State University School of Medicine in New Orleans, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Charles Medical Services Urology LLCGroup PAC ID 4284738063, 5 clinicians

Practice addresses (Care Compare)

2770 3Rd Ave
Suite 240
Lake Charles, LA 70601-8994
Phone (337) 494-4656

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection11

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.023910.RLAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Charles Medical Services Urology LLC Urology CurrentSince Jan 2, 2007 Accepting new patients
LCMS Pulmonary Associates of Southwest Louisiana Past Accepting new patients

Locations

1715 Wolf Cir
Lake Charles, LA 70605
Phone (337) 480-7499

2016 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 429-5248

2770 3rd Ave
Ste 240
Lake Charles, LA 70601
Phone (337) 494-4656

619 S Huntington St
Sulphur, LA 70663
Phone (337) 494-3278

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 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1598770869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122525 DEPT 2525",
            "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": "2770 3RD AVE STE 240",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018994",
            "telephone_number": "337-494-4656",
            "fax_number": "337-494-4657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UPSHAW",
        "first_name": "JOHN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-29",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "LA",
            "license": "MD.023910.R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1577731",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "MD.023910.R",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.