NPIMap

Individual provider Active NPI

Kevin John Bordelon, M.D.

  • Internal Medicine Physician
  • Marksville, LA
National Provider Identifier
1972506491
Registry record updated Jan 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
023281 Issued in LA
Practice address
4239 Highway 1192
Suite 200
Marksville, LA 71351-4771
Phone
(318) 253-8600
Fax
(318) 253-8654
NPI assigned
May 30, 2005
Last updated
Jan 4, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 4, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 023281 LA Primary

Addresses

Primary practice location

4239 Highway 1192
Suite 200
Marksville, LA 71351-4771

Mailing address

4239 Highway 1192
Suite 200
Marksville, LA 71351-4771
Phone (318) 253-8600

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
I20050309000307 LA Practitioner - Internal Medicine 2365490653 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Louisiana State University School of Medicine in Shreveport, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CLHG-Avoyelles LLCGroup PAC ID 8921380528, 39 clinicians

Practice addresses (Care Compare)

4239 Hwy 1192
Suite 300
Marksville, LA 71351-4772
Phone (318) 253-8611

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
023281LAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
CLHG-Avoyelles LLC CurrentSince Feb 1, 2023 Accepting new patients
CLHG-Avoyelles LLC Current Accepting new patients
Hawkeye Medical, LLC CurrentSince Sep 19, 2024 Accepting new patients
CLHG-Avoyelles LLC CurrentSince Feb 1, 2023 Accepting new patients
CLHG-Avoyelles, LLC Past Accepting new patients

Locations

4231 Highway 1192
Marksville, LA 71351
Phone (318) 240-6000

4239 Highway 1192
Ste 300
Marksville, LA 71351
Phone (318) 253-0677

Interoperability endpoints

  • Direct secure messaging: drkevinbordelon@aacapmc-la.direct.office.nextgen.com
  • Direct secure messaging: kevin.bordelon.1@16696.direct.athenahealth.com
  • Direct secure messaging: kevin.bordelon.1@30808.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1117411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294099200000",
    "number": "1972506491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4239 HIGHWAY 1192",
            "address_2": "SUITE 200",
            "city": "MARKSVILLE",
            "state": "LA",
            "postal_code": "713514771",
            "telephone_number": "318-253-8600",
            "fax_number": "318-253-8654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4239 HIGHWAY 1192",
            "address_2": "SUITE 200",
            "city": "MARKSVILLE",
            "state": "LA",
            "postal_code": "713514771",
            "telephone_number": "318-253-8600",
            "fax_number": "318-253-8654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDELON",
        "first_name": "KEVIN",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-30",
        "last_updated": "2011-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "023281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marksville, LA

Sources for this page

Verify at the official NPI Registry.