NPIMap

Individual provider Active NPI

Kevin Robert Young, MD

  • Cardiovascular Disease Physician
  • Lake Charles, LA
National Provider Identifier
1861599847
Registry record updated Apr 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
12469R Issued in LA
Practice address
1717 Oak Park Blvd FL 2
Lake Charles, LA 70601-8990
Phone
(337) 494-3278
Fax
(337) 494-3240
NPI assigned
Sep 20, 2006
Last updated
Apr 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 12469R LA Primary

Addresses

Primary practice location

1717 Oak Park Blvd FL 2
Lake Charles, LA 70601-8990

Mailing address

PO Box 122152 Dept 2152
Dallas, TX 75312-2152
Phone (337) 494-2921

Other practice location 1

109 W 4th St
Deridder, LA 70634-4849
Phone (337) 494-3278

Other practice location 2

122 W 4th St
Dequincy, LA 70633-3508
Phone (337) 494-3278

Other practice location 3

1322 Elton Rd Ste P
Jennings, LA 70546-4100
Phone (337) 494-3278

Other practice location 4

913 E Kent Dr
Sulphur, LA 70663-5007
Phone (337) 524-3610

Other identifiers 2

IdentifierTypeStateIssuer
1535893MedicaidLA
MD.12469ROtherLASTATE LICENSE

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
I20040119000676 LA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 7113828484 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
University of Louisville School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Charles Memorial Heart and Vascular CenterGroup PAC ID 4082689914, 15 clinicians

Practice addresses (Care Compare)

1717 Oak Park Blvd
FL 2
Lake Charles, LA 70601-8990
Phone (337) 494-3278

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting22
Pacemaker insertion or repair30

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12469RLAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Louisiana Hospital Association Inc CurrentSince Jun 27, 2017 Accepting new patients
Lake Charles Memorial Heart and Vascular Center Cardiovascular Disease CurrentSince Mar 1, 2009 Accepting new patients
Southwest Louisiana Hospital Association Inc CurrentSince Jun 27, 2017 Accepting new patients
Cardiovascular Specialists of Southwest Louisiana, LLC Cardiovascular Disease PastSince Jan 1, 2003 Accepting new patients
Mulhearn Medical, LLC Past Accepting new patients
Lake Charles Medical Services, Inc Past Accepting new patients

Locations

122 W 4th St
Dequincy, LA 70633
Phone (337) 401-4920

109 W 4th St
Deridder, LA 70634
Phone (337) 221-3004

801 S Pine St
Deridder, LA 70634
Phone (337) 462-0908

1322 Elton Rd
Ste P
Jennings, LA 70546
Phone (337) 494-3278

1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000

1717 Oak Park Blvd
Fl 2
Lake Charles, LA 70601
Phone (337) 474-5092

2770 3rd Ave
Ste 350
Lake Charles, LA 70601
Phone (337) 494-2750

913 E Kent Dr
Sulphur, LA 70663
Phone (337) 524-3610

Interoperability endpoints

  • Direct secure messaging: kyoung5281799@direct.casso.us.com

Organizations & group practices 6

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1861599847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 122152 DEPT 2152",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753122152",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 OAK PARK BLVD FL 2",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706018990",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "109 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Deridder",
            "state": "LA",
            "postal_code": "706344849",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "122 W 4th St",
            "address_purpose": "LOCATION",
            "city": "Dequincy",
            "state": "LA",
            "postal_code": "706333508",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1322 Elton Rd Ste P",
            "address_purpose": "LOCATION",
            "city": "Jennings",
            "state": "LA",
            "postal_code": "705464100",
            "country_code": "US",
            "telephone_number": "337-494-3278",
            "fax_number": "337-494-3240",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "913 E Kent Dr",
            "address_purpose": "LOCATION",
            "city": "Sulphur",
            "state": "LA",
            "postal_code": "706635007",
            "country_code": "US",
            "telephone_number": "337-524-3610",
            "fax_number": "337-527-6063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "KEVIN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "LA",
            "license": "12469R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1535893",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "MD.12469R",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

Verify at the official NPI Registry.