NPIMap

Individual provider Active NPI

Andres J Guillermo, M.D.

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1639379837
Registry record updated Aug 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD.203910 Issued in LA
Practice address
501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone
(337) 419-1958
Fax
(337) 419-1947
NPI assigned
Jul 25, 2007
Last updated
Aug 17, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD.203910 LA Primary

Addresses

Primary practice location

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724

Mailing address

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 312-8258

Other identifiers 1

IdentifierTypeStateIssuer
1005690MedicaidLA

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
I20101211000128 LA Practitioner - Family Practice 8426245747 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2010
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Imperial Health LLPGroup PAC ID 7719886779, 75 clinicians
Physical Therapy Services of West Louisiana IncGroup PAC ID 0446388763, 92 clinicians

Practice addresses (Care Compare)

1322 Elton Rd
Suite H
Jennings, LA 70546-4100
Phone (337) 246-7200

277N Hwy 171
Suite 8
Lake Charles, LA 70611-5374
Phone (337) 312-0030

301 W Fertitta Blvd
Suite 4
Leesville, LA 71446-4665
Phone (337) 238-9931

4201 Nelson Rd
Suite 100
Lake Charles, LA 70605-4117
Phone (337) 310-2273

501 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 433-8400

601 Dr Michael Debakey Dr
Lake Charles, LA 70601-5726
Phone (337) 436-1370

631 Dr Michael Debakey Dr
Lake Charles, LA 70601-5726
Phone (337) 433-4651

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.203910LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health, LLP Family Medicine CurrentSince Aug 1, 2016 Accepting new patients
Beauregard Medical and Surgical Center, LLC Family Medicine CurrentSince Aug 4, 2012 Accepting new patients
Imperial Health LLP CurrentSince Aug 1, 2016 Accepting new patients

Locations

301 S Washington St
Deridder, LA 70634
Phone (337) 460-7688

301 S Washington St
#A
Deridder, LA 70634
Phone (337) 460-7688

4201 Nelson Rd
Ste 100
Lake Charles, LA 70605
Phone (337) 310-2273

501 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8258

711 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8528

Interoperability endpoints

  • Direct secure messaging: andres.guillermo@1288.direct.myezyaccess.com

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1639379837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-312-8258",
            "fax_number": "337-312-6711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 DR MICHAEL DEBAKEY DR",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706015724",
            "telephone_number": "337-419-1958",
            "fax_number": "337-419-1947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLERMO",
        "first_name": "ANDRES",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-25",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "MD.203910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1005690",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.