NPIMap

Organization Active NPI

One Telemed LLC

  • Psychiatry Physician
  • Lafayette, LA
National Provider Identifier
1750808911
Registry record updated Aug 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ONE TELEMED LLC
Practice address
1001 W Pinhook Road
Building 3 Suite 219
Lafayette, LA 70503
Phone
(337) 565-0843
Fax
(337) 205-4150
NPI assigned
Aug 28, 2017
Last updated
Aug 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2017

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

Authorized official

Name
Mr. Charles Edwards
Title
Chief Executive Officer
Phone
(337) 565-0843

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Psychiatry Physician 2084P0800X NU Primary
Child & Adolescent Psychiatry Physician 2084P0804X NU

Addresses

Primary practice location

1001 W Pinhook Road
Building 3 Suite 219
Lafayette, LA 70503

Mailing address

1001 W Pinhook Road
Building 3 Suite 219
Lafayette, LA 70503
Phone (337) 565-0843

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220831002916 LA Part B Supplier - Clinic/Group Practice 2961886502 Receives reassigned benefits from 5 practitioners
Practice locations: Lafayette, LA

National Provider Directory

National Provider Directory

Locations

1001 W Pinhook Rd
Bldg 3
Lafayette, LA 70503
Phone (337) 255-0172

209 Garfield St
Lafayette, LA 70501
Phone (337) 565-0843

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503878400000",
    "number": "1750808911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 W PINHOOK ROAD",
            "address_2": "BUILDING 3 SUITE 219",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70503",
            "telephone_number": "337-565-0843",
            "fax_number": "337-205-4150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 W PINHOOK ROAD",
            "address_2": "BUILDING 3 SUITE 219",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70503",
            "telephone_number": "337-565-0843",
            "fax_number": "337-205-4150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE TELEMED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2017-08-28",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "337-565-0843",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.