Individual provider Active NPI

Annarita Nicosia, M.D.

  • Molecular Genetic Pathology (Medical Genetics) Physician
  • Baton Rouge, LA
National Provider Identifier
1740662899
Registry record updated Nov 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Molecular Genetic Pathology (Medical Genetics) PhysicianTaxonomy code 207SM0001X
License
330510 Issued in LA
Practice address
8415 Goodwood Blvd Ste 202B
Baton Rouge, LA 70806-7851
Phone
(225) 765-8988
Fax
(225) 765-1173
NPI assigned
Jun 25, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2022

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 MT209482 PA
Molecular Genetic Pathology (Medical Genetics) Physician 207SM0001X 330510 LA Primary

Addresses

Primary practice location

8415 Goodwood Blvd Ste 202B
Baton Rouge, LA 70806-7851

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (225) 765-8988

Other practice location 1

1 Baylor Plz
Houston, TX 77030-3411
Phone (713) 798-4951

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address anicosia4311180@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

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
I20220615001689 LA Practitioner - Pediatric MedicinePractitioner - Medical Genetics and Genomics 3274912605 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric MedicineAlso: Medical Genetics and Genomics
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

8415 Goodwood Blvd
Suite 202B
Baton Rouge, LA 70806-7851
Phone (225) 765-8988

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MT209482PAMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC Clinical Genetics (M.D.) CurrentSince Jun 6, 2022 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Jun 6, 2022 Accepting new patients

Locations

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

4950 Essen Ln
Ste 400
Baton Rouge, LA 70809
Phone (225) 765-1765

8200 Constantin Blvd
Fl 3
Baton Rouge, LA 70809
Phone (225) 765-1982

8415 Goodwood Blvd
Ste 202B
Baton Rouge, LA 70806
Phone (225) 765-8988

8200 Constantin Blvd
#3
Baton Rouge, LA 70809

8300 Constantin Blvd
Fl 3
Baton Rouge, LA 70809
Phone (225) 374-1485

Interoperability endpoints

  • Direct secure messaging: anicosia4311180@direct.casso.us.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1435190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667260800000",
    "number": "1740662899",
    "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": "225-765-8988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8415 GOODWOOD BLVD STE 202B",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708067851",
            "telephone_number": "225-765-8988",
            "fax_number": "225-765-1173"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Baylor Plz",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303411",
            "country_code": "US",
            "telephone_number": "713-798-4951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICOSIA",
        "first_name": "ANNARITA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-25",
        "last_updated": "2022-11-01",
        "certification_date": "2022-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": "MT209482",
            "primary": false
        },
        {
            "code": "207SM0001X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Molecular Genetic Pathology",
            "state": "LA",
            "license": "330510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "anicosia4311180@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "anicosia4311180@direct.casso.us.com",
            "address_1": "8415 Goodwood Blvd Ste 202B",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708067851",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/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": "8415 Goodwood Blvd Ste 202B",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708067851",
            "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.