Lavonne M Charbonneau, PA-C
Individual provider Active NPI Physician Assistant · Rolla, ND
NPI 1700867397 · NPPES record last updated Feb 18, 2010
Key facts
- NPI
- 1700867397
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PAC0002 (ND)
- Practice address
- 114 3Rd St NE
Rolla, ND 58367-7137 - Phone
- (701) 477-3111
- Fax
- (701) 477-6342
- NPI assigned
- Nov 10, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Presentation Medical Center
Practice addresses (Care Compare)
213 2ND Ave NE
Rolla, ND 58367-7153
Phone (701) 477-3161
Hospital & facility affiliations
- St Andrew'S Hospital
- Presentation Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ND, TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060522000060 | ND | Practitioner - Physician Assistant | 7719998160 | Reassigns benefits to 1 organization |
| I20130314000080 | TX | Practitioner - Physician Assistant | 7719998160 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PAC0002 | ND | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presentation Medical Center | Current |
Accepting new patients | |
| Presentation Medical Center | Past | Accepting new patients | |
| Rolla Clinic, P.C. | Past | Accepting new patients |
Interoperability endpoints
- lavonne.charbonneau.1@11280.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PAC0002 | ND | Yes |
Addresses
Primary practice location
114 3Rd St NE
Rolla, ND 58367-7137
Mailing address
PO Box 699
114 NE 3Rd St
Rolla, ND 58367-0699
Phone (701) 477-3111
Other providers in Rolla, ND
- Renae Ruth Williams Bonner
- Austen Boucher
- Caroline Bruce
- Myles Blake Brunelle
- Benjamin Bucher
- Lilia Marcelina Cid
- Tiffany Marie Clouse
- Commmunity Ambulance Service, Inc
- Carolyn Marie Counts
- Tammy R Counts
All providers in Rolla, ND · Physician Assistant in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.