NPIMap

Individual provider Active NPI

Kenneth Charles Civello Jr., MD, MPH

  • Clinical Cardiac Electrophysiology Physician
  • Baton Rouge, LA
National Provider Identifier
1699745562
Registry record updated Feb 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
201354 Issued in LA
Practice address
7777 Hennessy Blvd
Suite 1000
Baton Rouge, LA 70808-4300
Phone
(225) 767-3900
Fax
(225) 766-2226
NPI assigned
Jan 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2021

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 201354 LA
Cardiovascular Disease Physician 207RC0000X 35084798 OH
Clinical Cardiac Electrophysiology Physician 207RC0001X 35084798 OH
Clinical Cardiac Electrophysiology Physician 207RC0001X 201354 LA Primary

Addresses

Primary practice location

7777 Hennessy Blvd
Suite 1000
Baton Rouge, LA 70808-4300

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (222) 526-0001

Other identifiers 7

IdentifierTypeStateIssuer
1006122OtherOHQUAL
1108910MedicaidLA
114845OtherOHKAISER
E84798OtherOHSUMMA
000000364128OtherOHANTHEM
P00225594OtherRAILROAD MEDICARE
2515157MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kcivello13380@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epihosted.com/FHIRPoxy/api/FHIR/DSTU2/ Other

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
I20070511000238 LA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Cardiac Electrophysiology 3375506553 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Cardiac Electrophysiology
Education
Louisiana State University School of Medicine in New Orleans, 2000
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
Baton Rouge General Physicians IncGroup PAC ID 5193623643, 189 clinicians

Practice addresses (Care Compare)

7777 Hennessy Blvd
Suite 1000
Baton Rouge, LA 70808-4370

8585 Picardy Ave
Baton Rouge, LA 70809-3679

8595 Picardy Ave
Baton Rouge, LA 70809-3675

Hospital & facility affiliations

  • Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064
  • Baton Rouge General Medical Center Hospital, Baton Rouge, LA, CCN 190065
  • West Feliciana Parish Hospital Hospital, Saint Francisville, LA, CCN 191306

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
201354LAMDClinical Cardiac Electrophysiology Physician
35084798OHMDClinical Cardiac Electrophysiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Baton Rouge General Physicians, Inc. Cardiovascular Disease CurrentSince Oct 1, 2021 Accepting new patients
Riverside Medical Center Current Accepting new patients
Louisiana Cardiovascular Specialists, LLC CurrentSince Apr 28, 2026 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Jun 13, 2024 Accepting new patients
Louisiana Cardiovascular Specialists, LLC Cardiovascular Disease CurrentSince Feb 1, 2026 Accepting new patients
Baton Rouge General Physicians, Inc. CurrentSince Oct 1, 2021 Accepting new patients
Lsuhn Billing LLC CurrentSince Nov 1, 2015 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince May 31, 2018 Accepting new patients
Our Lady of the Lake Physician Group, LLC CurrentSince May 31, 2018 Accepting new patients
Lsuhn Billing LLC CurrentSince Nov 1, 2015 Accepting new patients
North Ohio Heart Center Inc Cardiovascular Disease Past Accepting new patients
Our Lady of the Lake Physician Group LLC Past Accepting new patients
Lake Emergency Services Inc Past Accepting new patients

Locations

6516 E Myrtle Ave
Baker, LA 70714
Phone (225) 774-7320

8595 Picardy Ave
Ste 202
Baton Rouge, LA 70809
Phone (225) 964-5514

7777 Hennessy Blvd
Ste 1000
Baton Rouge, LA 70808
Phone (225) 769-3900

8595 Picardy Ave
Ste 320
Baton Rouge, LA 70809
Phone (225) 237-1880

11424 Sullivan Rd
Baton Rouge, LA 70818
Phone (225) 261-9790

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011

7777 Hennessy Blvd
Ste 115
Baton Rouge, LA 70808
Phone (225) 233-1020

402 N Vaughan Dr
Brusly, LA 70719
Phone (225) 749-2645

31985 LA Highway 16
Ste B
Denham Springs, LA 70726
Phone (225) 767-1390

214 Clinic Dr
Donaldsonvlle, LA 70346
Phone (225) 473-8151

2647 S Saint Elizabeth Blvd
Ste 300
Gonzales, LA 70737
Phone (225) 647-0347

2390 W Congress St
Lafayette, LA 70506
Phone (337) 261-6000

160 Hospital Rd
New Roads, LA 70760
Phone (225) 638-4686

59315 River West Dr
#C
Plaquemine, LA 70764
Phone (225) 687-6629

610 N Jefferson Ave
Port Allen, LA 70767
Phone (225) 267-6626

1900 Main St
Sheridan, LA 70438
Phone (985) 839-4431

5000 Odonavan Blvd
Ste 307
Walker, LA 70785
Phone (225) 791-3117

Interoperability endpoints

  • Direct secure messaging: kcivello13380@direct.casso.us.com

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613001600000",
    "number": "1699745562",
    "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",
            "telephone_number": "222-526-0001",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD",
            "address_2": "SUITE 1000",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084300",
            "telephone_number": "225-767-3900",
            "fax_number": "225-766-2226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVELLO",
        "first_name": "KENNETH",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": "201354",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "35084798",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "OH",
            "license": "35084798",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "LA",
            "license": "201354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "QUAL",
            "identifier": "1006122",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1108910",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER",
            "identifier": "114845",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUMMA",
            "identifier": "E84798",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000364128",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00225594",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2515157",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kcivello13380@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "kcivello13380@direct.casso.us.com",
            "address_1": "7777 Hennessy Blvd",
            "address_2": "Suite 1000",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708084300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epihosted.com/FHIRPoxy/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": "7777 Hennessy Blvd",
            "address_2": "Suite 1000",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708084300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.