NPIMap

Individual provider Active NPI

Christian Jon Leblanc, MD

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1689115966
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
310323 Issued in LA
Practice address
4345 Nelson Rd Ste 102
Lake Charles, LA 70605-4183
Phone
(337) 480-7900
Fax
(337) 602-6358
NPI assigned
Mar 20, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 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 310323 LA Primary

Addresses

Primary practice location

4345 Nelson Rd Ste 102
Lake Charles, LA 70605-4183

Mailing address

PO Box 123594 Dept 3594
Dallas, TX 75312-3594
Phone (337) 494-2921

Other identifiers 2

IdentifierTypeStateIssuer
MD.310323OtherLASTATE MEDICAL LICENSE
2445251MedicaidLA

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
I20200616002717 LA Practitioner - Family Practice 2264702026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in New Orleans, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MMG Nelson Rd LLCGroup PAC ID 9032407663, 5 clinicians

Practice addresses (Care Compare)

4345 Nelson Rd
Suite 102
Lake Charles, LA 70605-4183
Phone (337) 480-7900

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
310323LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Diversified Health Care-Lake Charles, LLC Past Accepting new patients

Organizations & group practices 2

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 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1689115966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123594 DEPT 3594",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753123594",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4345 NELSON RD STE 102",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706054183",
            "telephone_number": "337-480-7900",
            "fax_number": "337-602-6358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEBLANC",
        "first_name": "CHRISTIAN",
        "middle_name": "JON",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-20",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "310323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "MD.310323",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2445251",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.