Individual provider Active NPI

Melissa Anne De la O, AU.D.

  • Audiologist
  • Monroe, LA
National Provider Identifier
1699266643
Registry record updated Jun 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
8159 Issued in LA
Practice address
2516 Broadmoor Blvd # 1B
Monroe, LA 71201
Phone
(318) 812-1125
NPI assigned
May 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 8159 LA Primary
Audiologist 231H00000X

Addresses

Primary practice location

2516 Broadmoor Blvd # 1B
Monroe, LA 71201

Mailing address

130 Desiard St Ste 355
Monroe, LA 71201-7363
Phone (318) 807-7875

Other practice location 1

2516 Broadmoor Blvd # 1B
Monroe, LA 71201
Phone (318) 812-1125

Other practice location 2

2516 Broadmoor Blvd # 1B
Monroe, LA 71201
Phone (318) 812-1125

Other identifiers 1

IdentifierTypeStateIssuer
2478877MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180801000861 LA Practitioner - Qualified Audiologist 0749538122 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
81.51 of 100Reported as apm
Quality
60.04
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8159LAMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Health Group, LLC CurrentSince Jul 9, 2018 Accepting new patients
Affinity Health Group, LLC CurrentSince Jul 9, 2018 Accepting new patients
Baton Rouge Clinic, a Medical Corporation CurrentSince Oct 1, 2024 Accepting new patients
Affinity Health Group, LLC Current Accepting new patients
Baton Rouge Clinic, a Medical Corporation CurrentSince Oct 1, 2024 Accepting new patients

Locations

7373 Perkins Rd
Baton Rouge, LA 70808
Phone (225) 246-9790

130 Desiard St
Ste 355
Monroe, LA 71201
Phone (318) 807-7875

2516 Broadmoor Blvd
#1B
Monroe, LA 71201
Phone (318) 812-1125

2408 Broadmoor Blvd
Ste 2
Monroe, LA 71201
Phone (318) 807-0525

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1527206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1699266643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 DESIARD ST STE 355",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712017363",
            "telephone_number": "318-807-7875",
            "fax_number": "318-812-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 BROADMOOR BLVD # 1B",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "71201",
            "telephone_number": "318-812-1125"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2516 Broadmoor Blvd # 1B",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "71201",
            "country_code": "US",
            "telephone_number": "318-812-1125",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2516 Broadmoor Blvd # 1B",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "LA",
            "postal_code": "71201",
            "country_code": "US",
            "telephone_number": "318-812-1125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE LA O",
        "first_name": "MELISSA",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-25",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "LA",
            "license": "8159",
            "primary": true
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2478877",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.