Active NPI
Deer Creek Medical Center
- Family Medicine Physician
- Leesville, LA
National Provider Identifier
1902835150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- DEER CREEK MEDICAL CENTER
- Practice address
- 301 W Fertitta Blvd Ste 1
Leesville, LA 71446-4665 - Phone
- (337) 238-0167
- Fax
- (337) 238-0574
- NPI assigned
- Jul 1, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa Thompson, CMPM
- Title
- Business Manager
- Phone
- (337) 238-0167
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
301 W Fertitta Blvd Ste 1
Leesville, LA 71446-4665
Mailing address
301 W Fertitta Blvd Ste 1
Leesville, LA 71446-4665
Phone (337) 238-0167
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1949477 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050321000045 | LA | Part B Supplier - Clinic/Group Practice | 1052366341 |
Receives reassigned benefits from 6 practitioners Practice locations: Leesville, LA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Leesville, LA
- NPI 1548422181
Family Medicine, LA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151712000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1306195200000",
"number": "1902835150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 W FERTITTA BLVD STE 1",
"city": "LEESVILLE",
"state": "LA",
"postal_code": "714464665",
"telephone_number": "337-238-0167",
"fax_number": "337-238-0574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 W FERTITTA BLVD STE 1",
"city": "LEESVILLE",
"state": "LA",
"postal_code": "714464665",
"telephone_number": "337-238-0167",
"fax_number": "337-238-0574"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DEER CREEK MEDICAL CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-01",
"last_updated": "2011-05-24",
"status": "A",
"authorized_official_last_name": "THOMPSON",
"authorized_official_first_name": "LISA",
"authorized_official_title_or_position": "BUSINESS MANAGER",
"authorized_official_telephone_number": "337-238-0167",
"authorized_official_credential": "CMPM"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1949477",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Leesville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; 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.