NPIMap

Individual provider Active NPI

Gerald Wade Mouton, MD

  • Family Medicine Physician
  • Lake Charles, LA
National Provider Identifier
1770634628
Registry record updated May 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
018271 Issued in LA
Practice address
2750 Aster St
Lake Charles, LA 70601-8824
Phone
(337) 480-8900
Fax
(337) 480-8901
NPI assigned
Jan 16, 2007
Last updated
May 12, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 018271 LA Primary

Addresses

Primary practice location

2750 Aster St
Lake Charles, LA 70601-8824

Mailing address

PO Box 122539
Dept 2539
Dallas, TX 75312-2539
Phone (337) 494-2921

Other practice location 1

1890 W Gauthier Rd Ste 155
Lake Charles, LA 70605-7119
Phone (337) 480-5550

Other practice location 2

217 Sam Houston Jones Pkwy Ste 104
Lake Charles, LA 70611-5644
Phone (337) 480-8989

Other identifiers 2

IdentifierTypeStateIssuer
1357880MedicaidLA
52011DD92OtherLAMEDICARE

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
I20080714000478 LA Practitioner - Family Practice 7113090846 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in New Orleans, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2750 Aster St
Lake Charles, LA 70601-8824
Phone (337) 480-8900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue279
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
018271LAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Charles Medical Services Family Practice Associates, LLC Family Medicine CurrentSince Aug 1, 2008 Accepting new patients
Southwest Louisiana Hospital Association Inc Past Accepting new patients

Locations

1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000

1890 W Gauthier Rd
Ste 155
Lake Charles, LA 70605
Phone (337) 477-6061

217 Sam Houston Jones Pkwy
Ste 104
Lake Charles, LA 70611
Phone (337) 480-8989

2750 Aster St
Lake Charles, LA 70601
Phone (337) 480-8900

2770 3rd Ave
Fl 2
Lake Charles, LA 70601
Phone (337) 477-8252

2800 2nd Ave
Ste C
Lake Charles, LA 70601
Phone (337) 474-2082

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lake Charles Memorial HospitalLake Charles, LA, CCN 19T060 Hospital Corporate Officer Jan 1, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1770634628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122539",
            "address_2": "DEPT 2539",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122539",
            "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": "2750 ASTER ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018824",
            "telephone_number": "337-480-8900",
            "fax_number": "337-480-8901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1890 W Gauthier Rd Ste 155",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706057119",
            "country_code": "US",
            "telephone_number": "337-480-5550",
            "fax_number": "337-480-5568",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "217 Sam Houston Jones Pkwy Ste 104",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706115644",
            "country_code": "US",
            "telephone_number": "337-480-8989",
            "fax_number": "337-480-8988",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOUTON",
        "first_name": "GERALD",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "018271",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1357880",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "52011DD92",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.