Individual provider Active NPI

Charles Balette, M.D.

  • Family Medicine Physician
  • Covington, LA
National Provider Identifier
1851358816
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12664R Issued in LA
Practice address
1119 S Tyler St
Covington, LA 70433
Phone
(985) 875-9166
Fax
(985) 875-9170
NPI assigned
Apr 26, 2006
Last updated
Jun 28, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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 12664R LA Primary

Addresses

Primary practice location

1119 S Tyler St
Covington, LA 70433

Mailing address

1417 Stillwater Dr
Mandeville, LA 70471-7452
Phone (985) 875-9166

Other identifiers 1

IdentifierTypeStateIssuer
1539571MedicaidLA

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080117000463 LA Practitioner - Family Practice 5193812246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1119 S Tyler St
Covington, LA 70433-2327
Phone (985) 875-9166

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12664RLAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northshore Family Medicine, LLC Family Medicine CurrentSince Sep 25, 2007 Accepting new patients
Lmchh PCP LLC Past Accepting new patients

Locations

1119 S Tyler St
Covington, LA 70433
Phone (985) 875-9166

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1851358816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 STILLWATER DR",
            "city": "MANDEVILLE",
            "state": "LA",
            "postal_code": "704717452",
            "telephone_number": "985-875-9166",
            "fax_number": "985-875-9170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 S TYLER ST",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "70433",
            "telephone_number": "985-875-9166",
            "fax_number": "985-875-9170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALETTE",
        "first_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "12664R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1539571",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

Verify at the official NPI Registry.