Individual provider Active NPI

Lakisah Bastian, MD

  • Internal Medicine Physician
  • Gretna, LA
National Provider Identifier
1730354630
Registry record updated Jan 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
203411 Issued in LA
Practice address
175 Hector Ave
Gretna, LA 70056-2590
Phone
(504) 349-6925
Fax
(504) 362-5310
NPI assigned
Apr 23, 2008
Last updated
Jan 31, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 203411 LA Primary

Addresses

Primary practice location

175 Hector Ave
Gretna, LA 70056-2590

Mailing address

175 Hector Ave
Gretna, LA 70056-2590
Phone (504) 349-6925

Other identifiers 1

IdentifierTypeStateIssuer
1002224MedicaidLA

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
I20110209000489 LA Practitioner - Internal Medicine 6901086842 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Geffen School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Orleans Physician Services IncGroup PAC ID 5294057824, 177 clinicians

Practice addresses (Care Compare)

175 Hector Ave
Gretna, LA 70056-2590
Phone (504) 349-6925

4513 Westbank Expressway
Marrero, LA 70072
Phone (504) 349-6360

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.64 of 100Reported as group
Quality
68.02
Improvement activities
40
Cost
76.01

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
203411LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Orleans Physician Services Inc Internal Medicine CurrentSince Feb 1, 2015 Accepting new patients
Culicchia Neurological Clinic, LLC Past Accepting new patients

Locations

2845 Manhattan Blvd
Harvey, LA 70058
Phone (504) 349-6930

1101 Medical Center Blvd
Marrero, LA 70072
Phone (504) 347-5511

175 Hector Ave
Terrytown, LA 70056
Phone (504) 349-6925

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1208908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391126400000",
    "number": "1730354630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 HECTOR AVE",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700562590",
            "telephone_number": "504-349-6925",
            "fax_number": "504-362-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 HECTOR AVE",
            "city": "GRETNA",
            "state": "LA",
            "postal_code": "700562590",
            "telephone_number": "504-349-6925",
            "fax_number": "504-362-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIAN",
        "first_name": "LAKISAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-23",
        "last_updated": "2014-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "203411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002224",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gretna, LA

Sources for this page

Verify at the official NPI Registry.