Centerwell Senior Primary Care (la) PC
Organization Active NPI Internal Medicine Physician · Baker, LA
NPI 1962276956 · NPPES record last updated Nov 9, 2023
Key facts
- NPI
- 1962276956
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- CENTERWELL SENIOR PRIMARY CARE (LA) PC
- Practice address
- 6404 Groom Rd
Baker, LA 70714-4364 - Phone
- (225) 614-9065
- NPI assigned
- Nov 9, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTERWELL SENIOR PRIMARY CARE (LA) PC
Authorized official
- Name
- Angie Martinez
- Title
- Senior Credentialing Professional
- Phone
- (407) 447-7120
Other NPIs on the same Medicare enrollment 13
Corporate family (same tax ID) 13
Practitioners 2
-
Shawn Dearie, NP
-
Michaela Cheyenne Wells, NP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 19D2298925 | Centerwell Senior Primary Care-Baker | Certificate of waiver | Feb 9, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210217000212 | LA | Part B Supplier - Clinic/Group Practice | 1951712280 |
Receives reassigned benefits from 60 practitioners 13 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Denham Springs, LA; Slidell, LA; Shreveport, LA; Prairieville, LA; Opelousas, LA; New Orleans, LA; Marrero, LA; Lake Charles, LA… |
National Provider Directory
- Tax ID family
- Centerwell Senior Prim Care
- Part of
- Centerwell Senior Prim Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | |||
| Internal Medicine Physician |
207R00000X | Yes | ||
| General Practice Physician |
208D00000X |
Addresses
Primary practice location
6404 Groom Rd
Baker, LA 70714-4364
Mailing address
4700 Millenia Blvd Ste 650
Orlando, FL 32839-6013
Phone (407) 447-7120
Other names
- CenterWell Senior Primary Care- Baker
Other providers in Baker, LA
- Dana Ashley Carbo
- Careon Wheels Transportation Service LLC
- Kyra Deshaurn Carey
- Merian Carter
- Cataldie Publishing LLC
- Centrepointe Medical Transportation
- Seymonia Cheeks
- Christian Rehabilitation Center LLC
- City of Baker School Board
- City of Baker School District
All providers in Baker, LA · Internal Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2023. 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.