Individual provider Active NPI

Jordan Douglas Percle

  • Hospitalist Physician
  • Baton Rouge, LA
National Provider Identifier
1952797482
Registry record updated Jun 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
303195 Issued in LA
Practice address
5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone
(225) 765-4050
Fax
(225) 765-4046
NPI assigned
Apr 10, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X PGY.202766 LA
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 303195 LA Primary

Addresses

Primary practice location

5000 Hennessy Blvd
Baton Rouge, LA 70808

Mailing address

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Phone (225) 765-4050

Other practice location 1

300 Holiday Dr
Thibodaux, LA 70301-3743
Phone (985) 227-3793

Other practice location 2

300 Holiday Dr
Thibodaux, LA 70301-3743
Phone (985) 227-3793

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jpercle11954@direct.casso.us.com Direct
FHIR URL https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180814001011 LA Practitioner - Internal Medicine 3274831342 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in New Orleans, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Our Lady of the Lake Physician Group LLCGroup PAC ID 4587849781, 637 clinicians

Practice addresses (Care Compare)

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Phone (225) 765-4050

Hospital & facility affiliations

  • Pinnacle Hospice Hospice, Baton Rouge, LA, CCN 191662
  • Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
PGY.202766LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of the Lake Physician Group LLC Internal Medicine CurrentSince Jul 1, 2019 Accepting new patients
Lsuhn Billing LLC CurrentSince Jul 1, 2018 Accepting new patients
Lsuhn Billing LLC CurrentSince Jul 1, 2018 Accepting new patients
Our Lady of the Lake Physician Group LLC CurrentSince Jul 1, 2019 Accepting new patients
Our Lady of the Lake Hospital Inc. Past Accepting new patients

Locations

5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone (225) 765-4050

1125 W Highway 30
Gonzales, LA 70737
Phone (225) 621-2975

2390 W Congress St
Lafayette, LA 70506
Phone (337) 261-6000

Interoperability endpoints

  • FHIR API: https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/R4/

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1952797482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708084375",
            "telephone_number": "225-765-4050",
            "fax_number": "225-765-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 HENNESSY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "70808",
            "telephone_number": "225-765-4050",
            "fax_number": "225-765-4046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Holiday Dr",
            "address_purpose": "LOCATION",
            "city": "Thibodaux",
            "state": "LA",
            "postal_code": "703013743",
            "country_code": "US",
            "telephone_number": "985-227-3793",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Holiday Dr",
            "address_purpose": "LOCATION",
            "city": "Thibodaux",
            "state": "LA",
            "postal_code": "703013743",
            "country_code": "US",
            "telephone_number": "985-227-3793",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERCLE",
        "first_name": "JORDAN",
        "middle_name": "DOUGLAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "PGY.202766",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "LA",
            "license": "303195",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpercle11954@direct.casso.us.com",
            "affiliation": "N",
            "endpointDescription": "FMOLHS-Epic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "jpercle11954@direct.casso.us.com",
            "address_1": "5000 Hennessy Blvd",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "70808",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0830.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "FMOLHS FHIR URL",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5000 Hennessy Blvd",
            "city": "Baton Rouge",
            "state": "LA",
            "country_code": "US",
            "postal_code": "70808",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.