Northlake Gastroenterology

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

NORTHLAKE GASTROENTEROLOGY

Practice address

16061 Doctors Blvd
Suite B
Hammond, LA 70403-1479

Phone

(985) 542-1334

Fax

(985) 318-1004

NPI assigned

Aug 17, 2005

Last updated

Aug 17, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Roy Holder

Title

Administrator

Phone

(985) 542-1334

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 12

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.

• Dennis Joseph Booth, M.D.

  • Specialist
  • Hammond, LA
  • NPI 1639174741
  Medicare reassignment Care Compare group NPD
• Lara Hutchinson Boudreaux, MD

  • Gastroenterology Physician
  • Covington, LA
  • NPI 1992267272
  Medicare reassignment Care Compare group NPD
• Lawrence Larry Gensler, M.D.

  • Specialist
  • Covington, LA
  • NPI 1841295953
  Medicare reassignment Care Compare group NPD
• Gregory Mark Mula, M.D.

  • Specialist
  • Hammond, LA
  • NPI 1265437362
  Medicare reassignment Care Compare group NPD
• Wendi Neal, FNP-C

  • Family Nurse Practitioner
  • Hammond, LA
  • NPI 1396200960
  Medicare reassignment Care Compare group NPD
• Wendy R Peterson, CFNP

  • Family Nurse Practitioner
  • Covington, LA
  • NPI 1841443272
  Medicare reassignment Care Compare group NPD
• Alisa Picou, FNP-C

  • Family Nurse Practitioner
  • Hammond, LA
  • NPI 1346705100
  Medicare reassignment Care Compare group NPD
• Jason Benjamin Reina, MD

  • Specialist
  • Hammond, LA
  • NPI 1548236391
  Medicare reassignment Care Compare group NPD
• Russell J Wardlaw, MD

  • Specialist
  • Hammond, LA
  • NPI 1376734210
  Medicare reassignment Care Compare group NPD
• Roy Divittorio, MD

  • Diagnostic Radiology Physician
  • Hammond, LA
  • NPI 1679564264
  Medicare reassignment NPD
• Whitney Morgan, FNP-C

  • Family Nurse Practitioner
  • Hammond, LA
  • NPI 1740922400
  Medicare reassignment NPD
• Alexandra Evelyn Morgan, FNP-C

  • Family Nurse Practitioner
  • Sandy, UT
  • NPI 1831831593

  LA

  Medicare reassignment

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786924800000",
    "number": "1861484842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16061 DOCTORS BLVD STE B",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704031499",
            "telephone_number": "985-542-1334",
            "fax_number": "985-318-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16061 DOCTORS BLVD",
            "address_2": "SUITE B",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704031479",
            "telephone_number": "985-542-1334",
            "fax_number": "985-318-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAKE GASTROENTEROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-17",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A",
        "authorized_official_last_name": "HOLDER",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "985-542-1334",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "LA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Oaks Physician Group, LLC (North Oaks Physician Group)
• North Oaks Physician Group, LLC (Plaza Orthopedic Clinic)
• North Oaks Rehabilitation Hospital, LLC
• Northlake Counseling and Consulting, LLC
• Northlake Endoscopy, LLC
• Northlake Pathology LLC
• Northlake Rehab Professionals
• Northlake Rheumatology, Pmllc
• Northland Hearing Centers Inc (Sears Hearing Aid Centers)
• Northland Hearing Centers, Inc. (Audibel Hearing Center)

• Specialist in Hammond, LA
• Providers in Hammond, LA by specialty
• Specialist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; 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.