Childrens Clinic of Raceland LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

08233R Issued in LA

Legal business name

CHILDRENS CLINIC OF RACELAND LLC

Practice address

110 Acadia Park Dr
Raceland, LA 70394-2618

Phone

(985) 537-8687

Fax

(985) 537-8976

NPI assigned

Jun 5, 2007

Last updated

Mar 4, 2021By 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

Dr. Luisa Cuario Bacuta-Tagorda, MDNPI 1285650200

Title

Member Manager

Phone

(985) 537-8687

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• CHILDRENS CLINIC OF RACELAND Former legal business name

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 3

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.

• Luisa C Bacuta-Tagorda, MD

  • Pediatrics Physician
  • Raceland, LA
  • NPI 1285650200
  Medicare reassignment NPD Authorized official
• Lauren Anne Tagorda, MD

  • Pediatrics Physician
  • Raceland, LA
  • NPI 1386149144
  NPD
• Celeste Torres George, APRN

  • Family Nurse Practitioner
  • Raceland, LA
  • NPI 1760714695
  NPD (past)

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

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1902009350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ACADIA PARK DR",
            "city": "RACELAND",
            "state": "LA",
            "postal_code": "703942618",
            "telephone_number": "985-537-8687",
            "fax_number": "985-537-8976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 ACADIA PARK DR",
            "city": "RACELAND",
            "state": "LA",
            "postal_code": "703942618",
            "telephone_number": "985-537-8687",
            "fax_number": "985-537-8976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDRENS CLINIC OF RACELAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-05",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "BACUTA-TAGORDA",
        "authorized_official_first_name": "LUISA",
        "authorized_official_middle_name": "CUARIO",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "985-537-8687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "LA",
            "license": "08233R",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "08233R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1819336",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHILDRENS CLINIC OF RACELAND",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "CHILDRENS CLINIC OF RACELAND",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Callie Champagne
• Lindsey Henderson Champagne, NP
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• Brittany Grabert Chauvin, PTA
• Flint David Cheramie, M. A.
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• Brittaney Hebert Corso, CNM
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• Robert S Crochet, CRNA
• Mayra Marie Cucullu, PHARM.D.

• Pediatrics Physician in Raceland, LA
• Providers in Raceland, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.