NPIMap

Organization Active NPI

St. Elizabeth-Mary Bird Perkins Cancer Center, L.L.C.

  • Radiation Oncology Physician
  • Gonzales, LA
National Provider Identifier
1619155124
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
ST. ELIZABETH-MARY BIRD PERKINS CANCER CENTER, L.L.C.
Practice address
1104 W Highway 30
Gonzales, LA 70737-5003
Phone
(225) 215-1223
Fax
(225) 766-0218
NPI assigned
Feb 6, 2008
Last updated
Dec 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2025

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

Authorized official

Name
Jacob Kraft
Title
Decision Support Manager
Phone
(225) 215-1281

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0904X
Radiation Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0001X Primary
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X
Therapeutic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0203X

Addresses

Primary practice location

1104 W Highway 30
Gonzales, LA 70737-5003

Mailing address

5215 Essen LN Ste 200
Baton Rouge, LA 70809-3543
Phone (225) 215-1281

Other identifiers 1

IdentifierTypeStateIssuer
1369306MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130611000874 LA Part B Supplier - Clinic/Group Practice 8628222551 Receives reassigned benefits from 28 practitioners
Practice locations: Gonzales, LA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5215 Essen Ln
Baton Rouge, LA 70809

8166 Main St
Ste 101
Houma, LA 70360
Phone (985) 876-9045

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 33

NPI Registry JSON

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766016000000",
    "number": "1619155124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 ESSEN LN STE 200",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708093543",
            "telephone_number": "225-215-1281",
            "fax_number": "225-215-1380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 W HIGHWAY 30",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707375003",
            "telephone_number": "225-215-1223",
            "fax_number": "225-766-0218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. ELIZABETH-MARY BIRD PERKINS CANCER CENTER, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A",
        "authorized_official_last_name": "KRAFT",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "DECISION SUPPORT MANAGER",
        "authorized_official_telephone_number": "225-215-1281"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0203X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Therapeutic Radiology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1369306",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gonzales, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2025; 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.