NPIMap

Organization Active NPI

Lafayette Health Ventures, Inc

Doing business as Executive Health

  • Internal Medicine Physician
  • Broussard, LA
National Provider Identifier
1699447243
Registry record updated Oct 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LAFAYETTE HEALTH VENTURES, INC
Doing business as
Executive Health
Practice address
1122 South Bernard
Suite C
Broussard, LA 70518-3408
Phone
(337) 703-6476
Fax
(337) 703-6477
NPI assigned
Oct 1, 2021
Last updated
Oct 19, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
LAFAYETTE HEALTH VENTURES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2021

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

Authorized official

Name
Kim Dooley
Title
VP
Phone
(337) 571-1394

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1122 South Bernard
Suite C
Broussard, LA 70518-3408

Mailing address

PO Box 919229
Dallas, TX 75391-9229
Phone (337) 289-8944

Other names 1

  • Executive Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041105000263 LA Part B Supplier - Clinic/Group Practice 9335043074 Receives reassigned benefits from 428 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lafayette Health Ventures Inc24 organizations share this tax ID, including this one
Part of
Lafayette Health Ventures Inc

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

1325 Wright Ave
Ste H
Crowley, LA 70526
Phone (337) 785-5440

711 N Montgomery Ave
Kaplan, LA 70548
Phone (318) 643-1747

1000 W Pinhook Rd
Ste 310
Lafayette, LA 70503
Phone (337) 233-9900

Practitioners & affiliated clinicians

Practitioners 59

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 59

NPI Registry JSON

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634601600000",
    "number": "1699447243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 919229",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753919229",
            "telephone_number": "337-289-8944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 SOUTH BERNARD",
            "address_2": "SUITE C",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705183408",
            "telephone_number": "337-703-6476",
            "fax_number": "337-703-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAFAYETTE HEALTH VENTURES, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAFAYETTE HEALTH VENTURES, INC",
        "enumeration_date": "2021-10-01",
        "last_updated": "2021-10-19",
        "certification_date": "2021-10-12",
        "status": "A",
        "authorized_official_last_name": "DOOLEY",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "337-571-1394"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Executive Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Executive Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Broussard, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.