Active NPI
Johnny Ray Biddle Jr., M.D.
- Family Medicine Physician
- Lake Charles, LA
National Provider Identifier
1902010952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 05629R
- Practice address
- 3608 Kirkman St
Lake Charles, LA 70607-3006 - Phone
- (337) 936-6893
- Fax
- (337) 564-0931
- NPI assigned
- May 9, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 05629R | LA | |
| Family Medicine Physician | 207Q00000X | 05629R | LA | Primary |
| General Practice Physician | 208D00000X | 05629R | LA |
Addresses
Primary practice location
3608 Kirkman St
Lake Charles, LA 70607-3006
Mailing address
630 W Prien Lake Rd
B 210
Lake Charles, LA 70601-0700
Phone (337) 936-6893
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1347795 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05629R | LA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sabine Emergency Medicine LLC | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447113600000",
"number": "1902010952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 W PRIEN LAKE RD",
"address_2": "B 210",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706010700",
"telephone_number": "337-936-6893",
"fax_number": "337-564-0931"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3608 KIRKMAN ST",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706073006",
"telephone_number": "337-936-6893",
"fax_number": "337-564-0931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BIDDLE",
"first_name": "JOHNNY",
"middle_name": "RAY",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-09",
"last_updated": "2015-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "LA",
"license": "05629R",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "LA",
"license": "05629R",
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "General Practice",
"state": "LA",
"license": "05629R",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1347795",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.