CCP Medical Management, LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

026036 Issued in LA

Legal business name

CCP MEDICAL MANAGEMENT, LLC

Practice address

213 Fourpark Rd
Suite C
Lafayette, LA 70507-2481

Phone

(337) 896-6400

Fax

(337) 896-6441

NPI assigned

Jan 14, 2008

Last updated

Jan 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Grover Phipps

Title

Partner

Phone

(337) 896-6400

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

CCP Medical Management LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• CCP Medical Management LLC

  • Primary Care Clinic/Center
  • Lafayette, LA
  • NPI 1952622664
  NPD tax ID

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1740466440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 FOURPARK RD",
            "address_2": "SUITE C",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705072481",
            "telephone_number": "337-896-6400",
            "fax_number": "337-896-6441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "213 FOURPARK RD",
            "address_2": "SUITE C",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705072481",
            "telephone_number": "337-896-6400",
            "fax_number": "337-896-6441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCP MEDICAL MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "PHIPPS",
        "authorized_official_first_name": "GROVER",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "337-896-6400"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "LA",
            "license": "026036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1447692",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Jude Cavanaugh, D.C
• Michael R. Cavanaugh, D.C.
• Shavondali Harris Cawthorne, PMHNP-BC, FNP-C
• CCFR, LLC (Premier Wellness)
• CCP Medical Management LLC
• CCP Primary Care Center
• CD Medical Transit LLC
• CD&J Management, LLC (Optimum Personal Care Services)
• CD&J Management, LLC (Optimum Personal Care Services)
• CD&J Management, LLC (Optimum Personal Care Services)

• Pain Medicine Physician in Lafayette, LA
• Providers in Lafayette, LA by specialty
• Pain Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.