NPIMap

Individual provider Active NPI

Brian Richard Harrell, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Lake Charles, LA
National Provider Identifier
1770613705
Registry record updated Apr 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
MD.201393 Issued in LA
Practice address
1525 Oak Park Blvd
Lake Charles, LA 70601
Phone
(377) 494-6767
Fax
(337) 494-6750
NPI assigned
Mar 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X MD.201393 LA Primary

Addresses

Primary practice location

1525 Oak Park Blvd
Lake Charles, LA 70601

Mailing address

PO Box 123453 Dept 3453
Dallas, TX 75312-0001
Phone (337) 494-2921

Other identifiers 2

IdentifierTypeStateIssuer
1501204MedicaidLA
MD.201393OtherLASTATE MEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100928001505 LA Practitioner - Family PracticePractitioner - Sports Medicine 5092895938 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD.201393LAMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Specialist, Apmc Past Accepting new patients
Heart of Hospice LLC Family Medicine Past Accepting new patients
Southwest Louisiana Hospital Association Inc Past Accepting new patients
Palliative Care at Heart, LLC PastSince Dec 1, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: bharrell5286578@direct.casso.us.com

Organizations & group practices 5

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.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Texas a & M University System, HSC, College of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lsuhsc Family Practice Center @ LCMH 8 clinicians

Practice addresses (Care Compare)

1525 Oak Park Blvd
Lake Charles, LA 70601-8849
Phone (337) 494-6767

Hospital & facility affiliations

  • Heart of Hospice Hospice, Lake Charles, LA, CCN 191642
  • Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060
  • West Calcasieu Cameron Hospital Hospital, Sulphur, LA, CCN 190013

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10
Skin biopsy1-10

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1770613705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123453 DEPT 3453",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 OAK PARK BLVD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "70601",
            "telephone_number": "377-494-6767",
            "fax_number": "337-494-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRELL",
        "first_name": "BRIAN",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "LA",
            "license": "MD.201393",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1501204",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE MEDICAL LICENSE",
            "identifier": "MD.201393",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.