NPIMap

Individual provider Active NPI

Todd Allen Peavy, MD

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1649205956
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
024836 Issued in LA
Practice address
1920 W Sale Rd
BLDG F Suite 1
Lake Charles, LA 70605-2400
Phone
(337) 475-2253
Fax
(337) 475-2253
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

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 024836 LA Primary

Addresses

Primary practice location

1920 W Sale Rd
BLDG F Suite 1
Lake Charles, LA 70605-2400

Mailing address

501 Dr Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 475-2252

Other identifiers 1

IdentifierTypeStateIssuer
1430501MedicaidLA

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
I20070907000302 LA Practitioner - Family Practice 4688767601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in Shreveport, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Imperial Health LLPGroup PAC ID 7719886779, 75 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Health LLP CurrentSince Jul 16, 2007 Accepting new patients
Imperial Health, LLP Family Medicine CurrentSince Jul 16, 2007 Accepting new patients
Southwest Louisiana Hospital Association Inc Past Accepting new patients
Southwest Louisiana Hospital Association Inc Family Medicine Past Accepting new patients

Locations

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

1920 W Sale Rd
Ste 1
Lake Charles, LA 70605
Phone (337) 475-2252

Interoperability endpoints

  • Direct secure messaging: todd.peavy@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 and National Provider Directory roles.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485734400000",
    "number": "1649205956",
    "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": "337-475-2252",
            "fax_number": "337-475-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 W SALE RD",
            "address_2": "BLDG F SUITE 1",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706052400",
            "telephone_number": "337-475-2253",
            "fax_number": "337-475-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEAVY",
        "first_name": "TODD",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2017-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "024836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1430501",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.