NPIMap

Organization Active NPI

MMG Archer Institute, LLC

Doing business as MMG Archer Institute

  • Psychiatry Physician
  • Lake Charles, LA
National Provider Identifier
1952897688
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MMG ARCHER INSTITUTE, LLC
Doing business as
MMG Archer Institute
Practice address
2829 4TH Ave Ste 150
Lake Charles, LA 70601-7897
Phone
(337) 480-7800
Fax
(337) 474-4552
NPI assigned
Jul 5, 2018
Last updated
Dec 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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

Authorized official

Name
Dawn Johnson-Hatcher
Title
Cfo
Phone
(337) 494-2094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

2829 4TH Ave Ste 150
Lake Charles, LA 70601-7897

Mailing address

PO Box 123977 Dept 3977
Dallas, TX 75312-0001
Phone (337) 494-2921

Other identifiers 1

IdentifierTypeStateIssuer
2509551MedicaidLA

Other names 1

  • MMG Archer Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190321002073 LA Part B Supplier - Clinic/Group Practice 7719227115 Receives reassigned benefits from 20 practitioners
Practice locations: Lake Charles, LA

National Provider Directory

National Provider Directory
Part of
Memorial Medical Group LLC

Locations

2000 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 474-3880

2615 Enterprise Blvd
Ste A
Lake Charles, LA 70601
Phone (337) 480-7800

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1530748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701648000000",
    "number": "1952897688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 123977 DEPT 3977",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753120001",
            "telephone_number": "337-494-2921",
            "fax_number": "337-494-6523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2829 4TH AVE STE 150",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017897",
            "telephone_number": "337-480-7800",
            "fax_number": "337-474-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMG ARCHER INSTITUTE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL MEDICAL GROUP",
        "enumeration_date": "2018-07-05",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-HATCHER",
        "authorized_official_first_name": "DAWN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "337-494-2094"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2509551",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMG Archer Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Dec 4, 2023; 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.

Verify at the official NPI Registry.