NPIMap

Individual provider Active NPI

Jacob Sebastien Bordelon

  • Physician Assistant
  • Lafayette, LA
National Provider Identifier
1912489279
Registry record updated Oct 4, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
310461 Issued in LA
Practice address
439 Heymann Blvd
Lafayette, LA 70503-2616
Phone
(337) 269-0963
NPI assigned
Sep 4, 2018
Last updated
Oct 4, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 310461 LA Primary

Addresses

Primary practice location

439 Heymann Blvd
Lafayette, LA 70503-2616

Mailing address

439 Heymann Blvd
Lafayette, LA 70503-2616
Phone (337) 269-0963

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
I20190115002450 LA Practitioner - Physician Assistant 3678819414 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Digestive Health Center of SwlaGroup PAC ID 3072782713, 9 clinicians

Practice addresses (Care Compare)

1701 Oak Park Blvd
Lake Charles, LA 70601-8911
Phone (337) 494-4785

2770 3Rd Ave
Suite 345
Lake Charles, LA 70601-8994
Phone (337) 494-4785

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lahasky Medical Clinic Apmc Past Accepting new patients
Southwest Louisiana Hospital Association Inc PastSince Oct 30, 2022 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jbordelon5281493@direct.casso.us.com

Organizations & group practices 4

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 10

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

NPI Registry JSON

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

{
    "created_epoch": "1536019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538611200000",
    "number": "1912489279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "439 HEYMANN BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032616",
            "telephone_number": "337-269-0963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "439 HEYMANN BLVD",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032616",
            "telephone_number": "337-269-0963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDELON",
        "first_name": "JACOB",
        "middle_name": "SEBASTIEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-04",
        "last_updated": "2018-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "310461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.