NPIMap

Organization Active NPI

Leatherwood Emergency Group, LLC

  • Emergency Medicine Physician
  • Oakdale, LA
National Provider Identifier
1760946313
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
LEATHERWOOD EMERGENCY GROUP, LLC
Practice address
130 Hospital Dr
Oakdale, LA 71463-3035
Phone
(318) 215-3084
NPI assigned
Jan 29, 2019
Last updated
Mar 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Authorized official

Name
Lisha C Falk
Title
VP of Contracting
Phone
(337) 609-1221

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X Primary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X

Addresses

Primary practice location

130 Hospital Dr
Oakdale, LA 71463-3035

Mailing address

200 Corporate Blvd
Lafayette, LA 70508-3870
Phone (800) 893-9698

Other identifiers 1

IdentifierTypeStateIssuer
2492683MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190410002335 LA Part B Supplier - Clinic/Group Practice 0749521250 Receives reassigned benefits from 43 practitioners
Practice locations: Oakdale, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647993600000",
    "number": "1760946313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CORPORATE BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705083870",
            "telephone_number": "800-893-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HOSPITAL DR",
            "city": "OAKDALE",
            "state": "LA",
            "postal_code": "714633035",
            "telephone_number": "318-215-3084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEATHERWOOD EMERGENCY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-29",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "status": "A",
        "authorized_official_last_name": "FALK",
        "authorized_official_first_name": "LISHA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VP OF CONTRACTING",
        "authorized_official_telephone_number": "337-609-1221"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2492683",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakdale, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2022; 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.