NPIMap

Individual provider Active NPI

John M Lipka, M.D.

  • Surgery Physician
  • Bastrop, LA
National Provider Identifier
1811972284
Registry record updated Sep 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
1021611 Issued in LA
Practice address
425 S Vine St
Bastrop, LA 71220-4513
Phone
(318) 281-5422
Fax
(318) 281-4416
NPI assigned
Dec 8, 2005
Last updated
Sep 12, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 1021611 LA Primary
Emergency Medicine Physician 207P00000X 1021611 LA

Addresses

Primary practice location

425 S Vine St
Bastrop, LA 71220-4513

Mailing address

425 S Vine St
Bastrop, LA 71220-4513
Phone (318) 281-5422

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
I20080324000073 LA Practitioner - General Practice 4183655566 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Louisiana State University School of Medicine in Shreveport, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sterlington Critical Access Hospital LLCGroup PAC ID 4486652385, shared by 6 NPIs, 12 clinicians

Practice addresses (Care Compare)

370 W Hickory
Bastrop, LA 71220-4442

PO Box
Suite 627
Sterlington, LA 71280

PO Box
Suite 627
Sterlington, LA 71280-0627

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1021611LAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sterlington Critical Access Hospital, L.L.C. PastSince Dec 1, 2007 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Southeast Rehabilitation HospitalLake Village, AR, CCN 043034 Hospital 5% Or Greater Direct Ownership Interest Nov 1, 2006
Sterlington Rehabilitation HospitalBastrop, LA, CCN 193069 Hospital 5% Or Greater Indirect Ownership Interest (12.5%) Nov 1, 2008
Sterlington Rural Health ClinicSterlington, LA, CCN 193473 Rural health clinic 5% Or Greater Direct Ownership Interest (12.5%) Mar 15, 2007
Sterlington Rehabilitation HospitalMer Rouge, LA, CCN 193486 Rural health clinic 5% Or Greater Direct Ownership Interest Dec 1, 2007
Bastrop Outpatient Rural Health ClinicBastrop, LA, CCN 193484 Rural health clinic 5% Or Greater Direct Ownership Interest Mar 1, 2008
Southeast Rural Health ClinicLake Village, AR, CCN 048523 Rural health clinic 5% Or Greater Direct Ownership Interest Mar 1, 2020

Owned or controlled facilities with NPI records 6

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

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473638400000",
    "number": "1811972284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 S VINE ST",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204513",
            "telephone_number": "318-281-5422",
            "fax_number": "318-281-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 S VINE ST",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204513",
            "telephone_number": "318-281-5422",
            "fax_number": "318-281-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIPKA",
        "first_name": "JOHN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2016-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "1021611",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "1021611",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bastrop, LA

Sources for this page

Verify at the official NPI Registry.