Individual provider Active NPI

Kraig S De Lanzac, M.D.

  • Anesthesiology Physician
  • Slidell, LA
National Provider Identifier
1609879139
Registry record updated Dec 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
10512R Issued in LA
Practice address
1001 Gause Blvd
Slidell, LA 70458-2939
Phone
(985) 649-8767
NPI assigned
May 30, 2005
Last updated
Dec 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 10512R LA Primary

Addresses

Primary practice location

1001 Gause Blvd
Slidell, LA 70458-2939

Mailing address

120 Innwood Dr
Covington, LA 70433-9123
Phone (985) 892-3225

Other identifiers 1

IdentifierTypeStateIssuer
1490075MedicaidLA

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
I20040511000230 LA Practitioner - Anesthesiology 8123017514 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Louisiana State University School of Medicine in New Orleans, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Childrens Hospital Anesthesia CorporationGroup PAC ID 0446152862, 281 clinicians

Practice addresses (Care Compare)

4700 S I 10 Service Rd W
Tulane Lakeside Hospital
Metairie, LA 70001-1210
Phone (504) 613-0711

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10512RLAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Administrators of the Tulane Educational Fund CurrentSince Mar 1, 2019 Accepting new patients
Administrators of the Tulane Educational Fund CurrentSince Mar 1, 2019 Accepting new patients
Childrens Hospital Anesthesia Corporation Anesthesiology CurrentSince Sep 1, 2023 Accepting new patients
Zephyr Anesthesia, LLC Anesthesiology CurrentSince Apr 1, 2023 Accepting new patients

Locations

694 Belle Terre Blvd
La Place, LA 70068
Phone (985) 359-6694

4200 Houma Blvd
Metairie, LA 70006
Phone (504) 454-4028

4700 S I 10 Svc Rd W
Metairie, LA 70001
Phone (504) 780-6453

1415 Tulane Ave
New Orleans, LA 70112
Phone (504) 588-2300

1532 Tulane Ave
New Orleans, LA 70112
Phone (504) 585-6485

200 Henry Clay Ave
New Orleans, LA 70118
Phone (504) 412-1860

2021 Perdido St
New Orleans, LA 70112
Phone (504) 412-1800

2701 Napoleon Ave
New Orleans, LA 70115
Phone (504) 267-2805

Organizations & group practices 4

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 4

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": "1117411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197072000000",
    "number": "1609879139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 INNWOOD DR",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704339123",
            "telephone_number": "985-892-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 GAUSE BLVD",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704582939",
            "telephone_number": "985-649-8767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE LANZAC",
        "first_name": "KRAIG",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-30",
        "last_updated": "2007-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "LA",
            "license": "10512R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1490075",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

Verify at the official NPI Registry.