Individual provider Active NPI

Robert Mackinnon Raulerson, M.D.

  • General Practice Physician
  • Monroe, LA
National Provider Identifier
1720021363
Registry record updated Jan 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
018874 Issued in LA
Practice address
920 Oliver Rd
Monroe, LA 71201-5702
Phone
(318) 807-4951
Fax
(318) 812-0808
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 018874 LA Primary

Addresses

Primary practice location

920 Oliver Rd
Monroe, LA 71201-5702

Mailing address

3339 Deborah Dr
Monroe, LA 71201-2150

Other identifiers 1

IdentifierTypeStateIssuer
1374580MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040817000947 LA Practitioner - General PracticePractitioner - Emergency MedicinePractitioner - Family Practice 0941273072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of Miami, LM Miller School of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Forsythe Family Medical Clinic, LLCGroup PAC ID 7810278231, 2 clinicians

Practice addresses (Care Compare)

5000 Forsythe Byp
Suite 118
Monroe, LA 71201-2168
Phone (318) 737-1381

Hospital & facility affiliations

  • Monroe Surgical Hospital Hospital, Monroe, LA, CCN 190245

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
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
018874LAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Forsythe Family Medical Clinic, LLC CurrentSince Feb 1, 2024 Accepting new patients
Affinity Health Group, LLC CurrentSince Jan 1, 2008 Accepting new patients
Affinity Health Group, LLC CurrentSince Jan 1, 2008 Accepting new patients
St Francis ER Physicians Past Accepting new patients

Locations

112 Saint John St
Monroe, LA 71201
Phone (318) 387-5681

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

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

920 Oliver Rd
Monroe, LA 71201
Phone (318) 807-6267

5000 Forsythe Byp
Ste 118
Monroe, LA 71201
Phone (318) 737-1381

Organizations & group practices 4

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 1

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1720021363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3339 DEBORAH DR",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712012150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 OLIVER RD",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015702",
            "telephone_number": "318-807-4951",
            "fax_number": "318-812-0808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAULERSON",
        "first_name": "ROBERT",
        "middle_name": "MACKINNON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "LA",
            "license": "018874",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1374580",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, LA

Sources for this page

Verify at the official NPI Registry.