Bluebonnet Imaging Center, LLC
Organization Active NPI Magnetic Resonance Imaging (MRI) Clinic/Center · Baton Rouge, LA
NPI 1942393699 · NPPES record last updated Oct 9, 2024
Key facts
- NPI
- 1942393699
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Magnetic Resonance Imaging (MRI) Clinic/Center 261QM1200X
- Legal business name
- BLUEBONNET IMAGING CENTER, LLC
- Practice address
- 4570 Bluebonnet Blvd.
Suite B
Baton Rouge, LA 70809 - Phone
- (225) 298-3223
- Fax
- (225) 298-5474
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
Authorized official
- Name
- John P Stagg
- Title
- Ceo
- Phone
- (225) 270-7077
Member of 1
Practitioners 60
-
Allen Douglas Acomb III, M.D.
-
Gerard A. Ballanco Jr., M.D.
-
Sharm El' Buras, MD
-
Stephanie D. Casey, M.D., M.P.H.
-
M. Jane Clayton, MD
-
Warren J Green, M.D.
-
Elorice Horam, M.D.
-
Michael Hoss, M.D.
-
Mohammad Ali Khan, M.D.
-
John G Lemieux, MD
-
Dale Moreland Maccurdy, M.D.
-
Michael P Nguyen, MD
-
Jeremy M Rau, M.D.
-
Christopher Rouse, M.D.
-
Daniel Robert Rovira, M.D.
-
Paula M. Sharkey, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D1081861 | Bluebonnet Imaging Center | Certificate of waiver | Mar 26, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070710000949 | LA | Part B Supplier - Independent Diagnostic Testing Facility (Idtf) | 3779683461 | Practice locations: Baton Rouge, LA |
National Provider Directory
Locations
7414 Picardy Ave
Ste A
Baton Rouge, LA 70808
Phone (225) 769-5064
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Magnetic Resonance Imaging (MRI) Clinic/Center | 261QM1200X | Yes |
Addresses
Primary practice location
4570 Bluebonnet Blvd.
Suite B
Baton Rouge, LA 70809
Mailing address
4241 Veterans Memorial Blvd Ste 200
Metairie, LA 70006-5430
Phone (504) 459-3220
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1025666 | Medicaid | LA |
Other providers in Baton Rouge, LA
- Kenneth McIver Blue Jr.
- Bluebonnet Dental Care
- Bluebonnet Dental Care @ Millbrook
- Bluebonnet Family Clinic, LLC
- Bluebonnet Healthcare, Inc.
- Bluebonnet Surgical Center LLC
- Bluebonnet Surgical Center LLC
- Bluebonnet Vision
- Katharine Elizabeth Blum
- Vincent Michael Blum
All providers in Baton Rouge, LA · Magnetic Resonance Imaging (MRI) Clinic/Center in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.