Heather Ellingson, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1503 Issued in LA

Practice address

723 E Highway 30
Gonzales, LA 70737-4715

Phone

(225) 743-2202

Fax

(225) 743-2028

NPI assigned

Mar 20, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hellingson2734823@direct.casso.us.com
• Direct secure messaging: heather.ellingson.1@30520.direct.athenahealth.com

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.

• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943
  Medicare reassignment Care Compare group NPD
• Doctor on Demand Professionals P C

  • Family Medicine Physician
  • San Francisco, CA
  • NPI 1174931448

  LA, Psychologist

  Medicare reassignment NPD
• Our Lady of the Angels Hospital, Inc.

  dba FMOL Health Our Lady of the Angels

  • General Acute Care Hospital
  • Bogalusa, LA
  • NPI 1912334533
  Medicare reassignment
• Our Lady of the Lake Physician Group LLC

  dba Our Lady of the Lake Children's Health Developmental Center at McMains

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Baton Rouge, LA
  • NPI 1235912502
  NPD
• Our Lady of the Lake Physician Group, LLC

  • Urgent Care Clinic/Center
  • Baton Rouge, LA
  • NPI 1588062079
  NPD
• Wash-St Tammany Reg Medical Center

  dba Bogalusa Medical Center

  • General Acute Care Hospital
  • Bogalusa, LA
  • NPI 1508809088
  NPD
• Our Lady of the Lake Physician Group LLC

  dba OLOL Physician Surgical Specialty

  • Hematology & Oncology Physician
  • Baton Rouge, LA
  • NPI 1184671455
  NPD (past)

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

{
    "created_epoch": "1616198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1679159768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 E HIGHWAY 30",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707374715",
            "telephone_number": "225-743-2202",
            "fax_number": "225-743-2028"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6400 Perkins Rd",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708084124",
            "country_code": "US",
            "telephone_number": "225-330-0497",
            "fax_number": "225-330-0498",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "214 Clinic Dr",
            "address_purpose": "LOCATION",
            "city": "Donaldsonville",
            "state": "LA",
            "postal_code": "703464309",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-473-4406",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "143 Highway 402 Ste 4",
            "address_purpose": "LOCATION",
            "city": "Napoleonville",
            "state": "LA",
            "postal_code": "703902217",
            "country_code": "US",
            "telephone_number": "985-369-1083",
            "fax_number": "985-369-1085",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "433 Plaza St",
            "address_purpose": "LOCATION",
            "city": "Bogalusa",
            "state": "LA",
            "postal_code": "704273729",
            "country_code": "US",
            "telephone_number": "985-730-6700",
            "fax_number": "985-730-6713",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1014 Saint Clair Blvd Ste 1010",
            "address_purpose": "LOCATION",
            "city": "Gonzales",
            "state": "LA",
            "postal_code": "707375023",
            "country_code": "US",
            "telephone_number": "225-743-2022",
            "fax_number": "225-743-2028",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "135 Highway 402",
            "address_purpose": "LOCATION",
            "city": "Napoleonville",
            "state": "LA",
            "postal_code": "703902217",
            "country_code": "US",
            "telephone_number": "985-369-4250",
            "fax_number": "985-369-6163",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "HEATHER",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-20",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "LA",
            "license": "1503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2573713",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1503",
            "state": "LA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hellingson2734823@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "hellingson2734823@direct.casso.us.com",
            "address_1": "721 E Highway 30",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707374715",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "721 E Highway 30",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707374715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Enhance Health Care Services PCS Waiver

• Clinical Psychologist in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Clinical Psychologist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.