NPIMap

Individual provider Active NPI

Marcus Ryan Davidson, PA-C

  • Physician Assistant
  • Lafayette, LA
National Provider Identifier
1962942839
Registry record updated Jul 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
309327 Issued in LA
Practice address
605 Silverstone Rd Ste 100
Lafayette, LA 70508
Phone
(337) 266-9985
NPI assigned
Feb 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2019

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 309327 LA Primary

Addresses

Primary practice location

605 Silverstone Rd Ste 100
Lafayette, LA 70508

Mailing address

605 Silverstone Rd Ste 100
Lafayette, LA 70508-6899
Phone (972) 393-5559

Other practice location 1

848 S Denton Tap Rd
100
Coppell, TX 75019-4556
Phone (972) 393-5559

Other practice location 2

605 Silverstone Rd Ste 100
Lafayette, LA 70508
Phone (337) 266-9985

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
I20200731000578 LA Practitioner - Physician Assistant 5597032748 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kelly L. Cobb, MD, ApmcGroup PAC ID 8224114269, 4 clinicians

Practice addresses (Care Compare)

605 Silverstone Rd
Suite 100
Lafayette, LA 70508-6899
Phone (337) 266-9985

Hospital & facility affiliations

  • Grace Home Health Home health agency, Lafayette, LA, CCN 197777
  • Ochsner Lafayette General Medical Center Hospital, Lafayette, LA, CCN 190002
  • Our Lady of Lourdes Regional Medical Center, Inc Hospital, Lafayette, LA, CCN 190102
  • Opelousas General Health System Hospital, Opelousas, LA, CCN 190017
  • Abbeville General Hospital Hospital, Abbeville, LA, CCN 190034
  • Iberia Medical Center Hospital, New Iberia, LA, CCN 190054

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: marcus.davidson.1@19751.direct.athenahealth.com

Organizations & group practices 1

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 7

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": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1962942839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 SILVERSTONE RD STE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705086899",
            "telephone_number": "972-393-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 SILVERSTONE RD STE 100",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "70508",
            "telephone_number": "337-266-9985"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "848 S Denton Tap Rd",
            "address_2": "100",
            "address_purpose": "LOCATION",
            "city": "Coppell",
            "state": "TX",
            "postal_code": "750194556",
            "country_code": "US",
            "telephone_number": "972-393-5559",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "605 Silverstone Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "70508",
            "country_code": "US",
            "telephone_number": "337-266-9985",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "MARCUS",
        "middle_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "309327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.