Individual provider Active NPI

Cory Lemoine, DO

  • Family Medicine Physician
  • Broussard, LA
National Provider Identifier
1760836597
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
309437 Issued in LA
Practice address
109 Saint Nazaire Rd
Broussard, LA 70518-4257
Phone
(337) 470-7450
Fax
(337) 839-0110
NPI assigned
Apr 18, 2016
Last updated
Mar 14, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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
Family Medicine Physician 207Q00000X 309437 LA Primary

Addresses

Primary practice location

109 Saint Nazaire Rd
Broussard, LA 70518-4257

Mailing address

5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816-6038
Phone (337) 470-7580

Other practice location 1

3801 North Blvd
Baton Rouge, LA 70806-3825
Phone (225) 387-7899

Other practice location 2

2647 S Saint Elizabeth Blvd Ste 308
Gonzales, LA 70737-5020
Phone (225) 765-5500

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address clemoine21666@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other
Direct Messaging Address clemoine21666@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
I20190730003424 LA Practitioner - Family Practice 6406149327 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
William Carey University College of Osteopathic Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lourdes Physician Group LLCGroup PAC ID 7214177757, 157 clinicians

Practice addresses (Care Compare)

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508-6917
Phone (337) 470-2990

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC Family Medicine CurrentSince Oct 10, 2022 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Oct 10, 2022 Accepting new patients
Lourdes Physician Group LLC Family Medicine CurrentSince May 10, 2019 Accepting new patients
Lourdes After Hours LLC CurrentSince Sep 26, 2019 Accepting new patients
Lourdes After Hours LLC CurrentSince Sep 26, 2019 Accepting new patients
Our Lady of the Lake Physician Group LLC Past Accepting new patients

Locations

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

109 Saint Nazaire Rd
Ste B
Broussard, LA 70518

3824 NE Evangeline Thruway
Carencro, LA 70520
Phone (337) 565-2675

2647 S Saint Elizabeth Blvd
Ste 308
Gonzales, LA 70737
Phone (225) 647-5017

302 Rue Louis Xiv
Lafayette, LA 70508

4525 Ambassador Caffery Pkwy
Lafayette, LA 70508

4801 Ambassador Caffery Pkwy
Lafayette, LA 70508
Phone (337) 470-2000

Interoperability endpoints

  • Direct secure messaging: clemoine21666@direct.casso.us.com

Organizations & group practices 6

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 6

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": "1460937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1760836597",
    "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": "337-470-7580",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 SAINT NAZAIRE RD",
            "city": "BROUSSARD",
            "state": "LA",
            "postal_code": "705184257",
            "telephone_number": "337-470-7450",
            "fax_number": "337-839-0110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3801 North Blvd",
            "address_purpose": "LOCATION",
            "city": "Baton Rouge",
            "state": "LA",
            "postal_code": "708063825",
            "country_code": "US",
            "telephone_number": "225-387-7899",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2647 S Saint Elizabeth Blvd Ste 308",
            "address_purpose": "LOCATION",
            "city": "Gonzales",
            "state": "LA",
            "postal_code": "707375020",
            "country_code": "US",
            "telephone_number": "225-765-5500",
            "fax_number": "225-765-9419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEMOINE",
        "first_name": "CORY",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-18",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "309437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clemoine21666@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "clemoine21666@direct.casso.us.com",
            "address_1": "109 Saint Nazaire Rd",
            "city": "Broussard",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705184257",
            "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": "109 Saint Nazaire Rd",
            "city": "Broussard",
            "state": "LA",
            "country_code": "US",
            "postal_code": "705184257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "clemoine21666@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "clemoine21666@direct.casso.us.com",
            "address_1": "2647 S Saint Elizabeth Blvd Ste 308",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375020",
            "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": "2647 S Saint Elizabeth Blvd Ste 308",
            "city": "Gonzales",
            "state": "LA",
            "country_code": "US",
            "postal_code": "707375020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Broussard, LA

Sources for this page

Verify at the official NPI Registry.