NPIMap

Organization Active NPI

Spine Diagnostic Center of Baton Rouge, Inc a Professional Medical Cor

Doing business as The Spine Diagnostic and Pain Treatment Center

  • Specialist
  • Baton Rouge, LA
National Provider Identifier
1790712214
Registry record updated Nov 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
17228 Issued in LA
Legal business name
SPINE DIAGNOSTIC CENTER OF BATON ROUGE, INC A PROFESSIONAL MEDICAL COR
Doing business as
The Spine Diagnostic and Pain Treatment Center
Practice address
5408 Flanders Dr
Baton Rouge, LA 70808-9168
Phone
(225) 769-5554
Fax
(225) 769-3334
NPI assigned
Jun 28, 2006
Last updated
Nov 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2021

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

Authorized official

Name
Danette Taylor Cargil
Title
Operations Manager
Phone
(225) 769-1786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 17228 LA Primary

Addresses

Primary practice location

5408 Flanders Dr
Baton Rouge, LA 70808-9168

Mailing address

PO Box 84128
10523 N Oak Hill Pkwy Ste. B
Baton Rouge, LA 70884-4128
Phone (225) 769-1786

Other names 1

  • The Spine Diagnostic and Pain Treatment Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040301001010 LA Part B Supplier - Clinic/Group Practice 8921995317 Receives reassigned benefits from 16 practitioners
Practice locations: Baton Rouge, LA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D1074936Spine Diagnostic and Pain Treatment Center the5408 Flanders Drive, Baton Rouge, LA 70808AccreditationOct 13, 2026

National Provider Directory

National Provider Directory

Locations

10523 N Oak Hills Pkwy
#B
Baton Rouge, LA 70810

155 Del Orleans Ave
#A
Denham Springs, LA 70726

14169 Highway 73
Prairieville, LA 70769

14169 Highway 73
Unit C
Prairieville, LA 70769

1673 E Mount Pleasant Rd
Zachary, LA 70791

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637625600000",
    "number": "1790712214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84128",
            "address_2": "10523 N OAK HILL PKWY STE. B",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708844128",
            "telephone_number": "225-769-1786",
            "fax_number": "225-769-1766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5408 FLANDERS DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089168",
            "telephone_number": "225-769-5554",
            "fax_number": "225-769-3334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE DIAGNOSTIC CENTER OF BATON ROUGE, INC A PROFESSIONAL MEDICAL COR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2021-11-23",
        "certification_date": "2021-11-23",
        "status": "A",
        "authorized_official_last_name": "CARGIL",
        "authorized_official_first_name": "DANETTE",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "225-769-1786"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "LA",
            "license": "17228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Spine Diagnostic and Pain Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Spine Diagnostic and Pain Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.