Alicia Renee Gautreau

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

130367 Issued in LA

Practice address

7777 Hennessy Blvd Ste 701
Baton Rouge, LA 70808-4370

Phone

(225) 765-5864

Fax

(225) 765-2013

NPI assigned

Jun 7, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Georgetown University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: agautreau36895@direct.casso.us.com

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.

• Our Lady of the Lake Physician Group LLC

  • Internal Medicine Physician
  • Baton Rouge, LA
  • NPI 1033494943

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Lallie Kemp Medical Ctr

  dba Lallie Kemp Regional Medical Center

  • Critical Access Hospital
  • Independence, LA
  • NPI 1558303420

  Nurse Practitioner

  Medicare reassignment NPD
• Lallie Kemp Medical Ctr

  dba Lallie Kemp Regional Medical Center

  • Critical Access Hospital
  • Independence, LA
  • NPI 1972545846
  NPD
• Our Lady of the Lake Physician Group LLC

  dba Our Lady of the Lake Children's Health Developmental Center at McMains

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Baton Rouge, LA
  • NPI 1235912502
  NPD

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

• Our Lady of the Lake Hospital Inc.

  dba Our Lady of the Lake Regional Medical Center

  • General Acute Care Hospital
  • Baton Rouge, LA
  • NPI 1366436123
  Care Compare affiliation

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609977600000",
    "number": "1811426554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5959 S SHERWOOD FOREST BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708166038",
            "telephone_number": "225-765-5727",
            "fax_number": "225-765-9196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7777 HENNESSY BLVD STE 701",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084370",
            "telephone_number": "225-765-5864",
            "fax_number": "225-765-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAUTREAU",
        "first_name": "ALICIA",
        "middle_name": "RENEE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-07",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "130367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "agautreau36895@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "agautreau36895@direct.casso.us.com",
            "address_1": "7777 Hennessy Blvd Ste 701",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708084370",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "7777 Hennessy Blvd Ste 701",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "708084370",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Leslie Marie Gauthier
• Thileasea Gauthier
• Debra Hinkle Gauthreaux, MS LOTR
• Farryn Gauthreaux
• Torri Gautier
• Charley R. Gautreau, APRN, FNP-C
• Christie L Gautreau, CRNA
• Jade Nicole Gautreau, P.A.
• Joshua Ryan Gautreau, LMT
• Lindsey Rose Gautreau

• Nurse Practitioner in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.