Andrew B Bernales, MD
Individual provider Active NPI Pediatrics Physician · Brusly, LA
NPI 1780104943 · NPPES record last updated Jun 2, 2022
Key facts
- NPI
- 1780104943
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 324080 (LA)
- Practice address
- 402 N Vaughan Dr
Brusly, LA 70719-2225 - Phone
- (225) 448-5321
- Fax
- (225) 448-5321
- NPI assigned
- Jun 20, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220817002836 | LA | Practitioner - Pediatric Medicine | 3870863467 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125069861 | IL | MD | Pediatrics Physician |
| 324080 | LA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Our Lady of the Lake Physician Group LLC | Current |
Accepting new patients | |
| Our Lady of the Lake Physician Group LLC | Pediatrics | Current |
Accepting new patients |
| Woman'S Hospital Foundation | Past | Accepting new patients |
Locations
5959 S Sherwood Forest Blvd
Baton Rouge, LA 70816
Phone (225) 526-0011
8415 Goodwood Blvd
Ste 100
Baton Rouge, LA 70806
Phone (225) 765-5633
402 N Vaughan Dr
Brusly, LA 70719
Phone (225) 749-2645
Interoperability endpoints
- abernales1803880@direct.casso.us.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 324080 | LA | Yes |
| Pediatrics Physician | 208000000X | 125069861 | IL |
Addresses
Primary practice location
402 N Vaughan Dr
Brusly, LA 70719-2225
Mailing address
PO Box 19658
Springfield, IL 62794-9658
Phone (217) 545-8000
Other practice location 1
301 N 8th St Ste 4A
Springfield, IL 62701-1013
Phone (217) 545-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2542605 | Medicaid | LA |
Other providers in Brusly, LA
- Baton Rouge Orthopaedic Clinic LLC
- BPH Enterprises, LLC
- Brightside Day Habilitation
- Brightside Day Habilitation, Inc
- Brightside Day Habilitation, Inc
- Normanique Latrice Butler
All providers in Brusly, LA · Pediatrics Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.